Acute Hyperglycemic Syndromes: Diabetic Ketoacidosis and the Hyperosmolar State

  • Adrienne M. Fleckman


After increasing urination and thirst, come nausea, vomiting and abdominal pain. Dehydration, weakness and dizziness follow. The patient is confused and slips into coma. The respiratory compensation that accompanies acidemia causes rapid breathing. The sweet smell of the volatile ketone body acetone signals the possibility of ketoacidosis.


Free Fatty Acid Ketone Body Total Body Water Diabetic Ketoacidosis Osmotic Diuresis 
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  1. 1.
    Umpierrez GE, Woo W, Hagopian WA, Isaacs SD, Palmer JP, Lakshmi K, Nepom GT, Clark WS, Mixon PS, Kitabchi AE. Immunogenetic analysis suggests different pathogenesis for obese and lean African-Americans with diabetic ketoacidosis. Diabetes Care 22: 1517–1523, 1999.PubMedCrossRefGoogle Scholar
  2. 2.
    Balasubramanyam A, Zern JW, Hyman DJ, Pavlik V. New profiles of diabetic ketoacidosis: type 1 vs type 2 diabetes and the effect of ethnicity. Arch Intern Med 159: 2317–2322, 1999.PubMedCrossRefGoogle Scholar
  3. 3.
    Winter WE, Maclaren NK, Riley WJ, Clarke DW, Kappy MS, Spillar RP. Maturity-onset diabetes of youth in black Americans. N Engl J Med 316: 285–291, 1987.PubMedCrossRefGoogle Scholar
  4. 4.
    Lebovitz HE. Diabetic ketoacidosis. Lancet 345: 767–772, 1995.PubMedCrossRefGoogle Scholar
  5. 5.
    Fleckman AM. Diabetic ketoacidosis. Endocrinol Metab Clin N Amer 22: 181–207, 1993.Google Scholar
  6. 6.
    The cell: a molecular approach. 1st Edition. Cooper GM. ASM Press, Washington, D.C., 39–85, 389–403, 1997.Google Scholar
  7. 7.
    Lehninger Principles of Biochemistry. Nelson DL, Cox MM, Eds; Worth Publishers, New York, 598–622, 869–903, 2000.Google Scholar
  8. 8.
    DeFronzo RA, Matsuda M, Barrett EJ. Diabetic ketoacidosis. Diabetes Rev 2: 209–238, 1994.Google Scholar
  9. 9.
    Ottosson M, Lönnroth P, Björntorp P, Edén S. Effects of cortisol and growth hormone on lipolysis in human adipose tissue. J Clin Endocrinol Metab 85: 799–803, 2000.PubMedCrossRefGoogle Scholar
  10. 10.
    Seckl JR, Walker BR. Minireview: llbeta-hydroxysteroid dehydrogenase type 1–a tissue-specific amplifier of glucocorticoid action. Endocrinol 142: 1371–1376, 2001.CrossRefGoogle Scholar
  11. 11.
    Zammit VA. Regulation of ketone body metabolism. Diabetes Rev 2: 132–155, 1994.Google Scholar
  12. 12.
    Laffel L. Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes/Metab Rev 15: 412–426, 1999.CrossRefGoogle Scholar
  13. 13.
    Brandenburg MA, Dire DJ. Comparison of arterial and venous blood bas values in the initial emergency department evaluation of patients with diabetic ketoacidosis. Ann Emerg Med 31: 459–465, 1998.PubMedCrossRefGoogle Scholar
  14. 14.
    Fulop M, Murthy V, Michili A, Nalamati J, Qian Q, Saitowitz A. Serum beta-hydroxybutyrate measurement in patients with uncontrolled diabetes mellitus. Arch Intern Med 159: 381–384, 1999.PubMedCrossRefGoogle Scholar
  15. 15.
    White NH. Diabetic ketoacidosis in children. Endocrinol Metab Clin 29: 657–682, 2000.CrossRefGoogle Scholar
  16. 16.
    Adrogue’ HJ, Barrero J, Eknoyan G: Salutary effects of modest fluid replacement in the treatment of adults with diabetic ketoacidosis. JAMA 262: 2108–2113, 1989.CrossRefGoogle Scholar
  17. 17.
    Kaufman FR. Diabetes in children and adolescents: areas of controversy. Med Clin No Amer 82: 721–738 1998.CrossRefGoogle Scholar
  18. 18.
    Muir A. Cerebral edema in diabetic ketoacidosis: a look beyond rehydration. J Clin Endocrinol Metab 85: 509–513, 2000.CrossRefGoogle Scholar
  19. 19.
    Edge JA, Ford-Adams ME, Dunger DB. Causes of death in children with insulin dependent diabetes 1990–96. Arch Disease Child 81: 318–323, 1999.CrossRefGoogle Scholar
  20. 20.
    Glaser N, Barnett P, McCaslin I, Nelson D, Trainor J, Louie J, Kaufman F, Quayle K, Roback M, Malley R, Kuppermann N. Risk factors for cerebral edema in children with diabetic ketoacidosis. N Engl J Med 344: 264–269, 2001.PubMedCrossRefGoogle Scholar
  21. 21.
    Isales CM, Min L, Hoffman WH. Acetoacetate and beta- hydroxybutyrate differentially regulate endothelin-1 and vascular endothelial growth factor in mouse brain microvascular endothelial cells. J Diabetes Complic 13: 91–97, 1999.CrossRefGoogle Scholar
  22. 22.
    Mahoney CP, Vicek BW, DelAguila M. Risk factors for developing brain herniation during diabetic ketoacidosis. Pediatr Neurol 21: 721–727, 1999.PubMedCrossRefGoogle Scholar
  23. 23.
    Wagner A, Risse A, Brill HL, Wienhausen-Wilke V, Rottman M, Sondern K, Angelkort B. Therapy of severe diabetic ketoacidosis: zero-mortality under very-low-dose insulin application. Diabetes Care 22: 674–677, 1999.PubMedCrossRefGoogle Scholar
  24. 24.
    Weiner ID, Wingo CS. Hypokalemia — consequences, causes, and correction. J Amer Soc Neph 8: 1179–1188, 1997.Google Scholar
  25. 25.
    Tattersall RB. A paper which changed clinical practice (slowly). Jacob Holler on potassium deficiency in diabetic acidosis (1946). Diabetic Med 16: 978–984, 1999.PubMedCrossRefGoogle Scholar
  26. 26.
    Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, Bertrand J. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med 27: 2690–2693, 1999.PubMedCrossRefGoogle Scholar
  27. 27.
    Vantyghem MC, Haye S, Balduyck M, Hober C, Degand PM, Lefebvre J. Changes in serum amylase, lipase and leukocyte elastase during diabetic ketoacidosis and poorly controlled diabetes. Acta Diabetol 36: 39–44, 1999.PubMedCrossRefGoogle Scholar
  28. 28.
    Nair S, Pitchumoni CS. Diabetic ketoacidosis, hyperlipidemia, and acute pancreatitis: the enigmatic triangle. Amer J Gastro 92: 1560–1561, 1997Google Scholar
  29. 29.
    Nair S, Yadav D, Pitchumoni CS. Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA. Amer J Gastro 95: 2795–2800, 2000.CrossRefGoogle Scholar
  30. 30.
    Fulop M, Eder H. Severe hypertriglyceridemia in diabetic ketosis. Amer J Med Sci 300: 361–365, 1990.PubMedCrossRefGoogle Scholar
  31. 31.
    Fisher JN, Kitabchi AE. A randomized study of phosphate therapy in the treatment of diabetic ketoacidosis. J Clin Endocrinol Metab 57: 177–180, 1983PubMedCrossRefGoogle Scholar
  32. 32.
    Hoffman WH, Locksmith JP, Burton EM, Hobbs E, Passmore GG, Pearson-Shaver AL, Deane DA, Beaudreau M, Bassali RW. Interstitial pulmonary edema in children and adolescents with diabetic ketoacidosis. J Diabetes Comp 12: 314–320, 1998.CrossRefGoogle Scholar
  33. 33.
    Podar T, Solntsev A, Reunanen A, Urbonaite B, Zalinkevicius R, Karvonen M, LaPorte RE, Tuomilehto J. Mortality in patients with childhood-onset type 1 diabetes in Finland, Estonia, and Lithuania: Follow-up of nationwide cohorts. Diabetes Care 23: 290–294, 2000.Google Scholar
  34. 34.
    Lipton R, Good G, Mikhailov T, Freels S, Donoghue E. Ethnic differences in mortality from insulin-dependent diabetes mellitus among people less than 25 years of age. Pediatrics 103: 952–956, 1999.PubMedCrossRefGoogle Scholar
  35. 35.
    Levetan CS, Passaro MD, Jablonski KA, Ratner RE. Effect of physician specialty on outcomes in diabetic ketoacidosis. Diabetes Care 22: 1790–1795, 1999.PubMedCrossRefGoogle Scholar
  36. 36.
    Javor KA, Kotsanos JG, McDonald RC, et al: Diabetic ketoacidosis charges relative to medical charges of adult patients with type 1 diabetes. Diabetes Care 20: 349–354, 1997.PubMedCrossRefGoogle Scholar
  37. 37.
    Vanelli M, Chiari G, Ghizzoni L, Costi G, Giacalone T, Chiarelli F. Effectiveness of a prevention program for diabetic ketoacidosis in children: an 8-year study in schools and private practices. Diabetes Care 22: 7–9, 1999.PubMedCrossRefGoogle Scholar
  38. 38.
    Bonadio WA, Gutzeit MF, Losek JD, et al. Outpatient management of diabetic ketoacidosis. Amer J Dis Child 142: 448–450, 1988.PubMedGoogle Scholar
  39. 39.
    Marinac JS, Jesa L. Using a severity of illness scoring system to assess intensive care unit admissions for diabetic ketoacidosis. Crit Care Med 28: 2238–2241, 2000.PubMedCrossRefGoogle Scholar
  40. 40.
    Banerji MA, Chaiken RL, Huey H, Tuomi T, Norin AJ, Mackay IR, Rowley JM, Zimmet PZ, Lebovitz HE. GAD antibody negatives NIDDM in adult black subjects with diabetic ketoacidosis and increased frequency of human leukocyte antigen DR3 and DR4. Flatbush diabetes. Diabetes 43: 741–745, 1994.PubMedCrossRefGoogle Scholar
  41. 41.
    Banerji MA, Chaiken RL, Lebovitz HE. Long-term normoglycemic remission in black newly diagnosed NIDDM subjects. Diabetes 45: 337341, 1996.Google Scholar
  42. 42.
    Matz R. Management of the hyperosmolar hyperglycemic syndrome. Am Fam Physician 60: 1468–1476, 1999.PubMedGoogle Scholar
  43. 43.
    Fulop M, Tannenbaum H, Dreyer N: Ketotic hyperosmolar coma. Lancet 2: 635–639, 1973.PubMedCrossRefGoogle Scholar
  44. 44.
    Daugirdas JT, Kronfol NO, Tzamaloukas AH, et al: Hyperosmolar coma: cellular dehydration and the serum sodium concentration. Ann Intern Med 110: 855–857, 1989.PubMedCrossRefGoogle Scholar
  45. 45.
    Ileri NS, Buyukasik Y, Karaahmetoglu S, Ozatli D, Sayinalp N, Ozcebe OI, Kirazli S, Muftuoglu O, Dundar SV. Evaluation of the haemostatic system during ketoacidotic deterioration of diabetes mellitus. Haemostasis 29: 318–325, 1999.PubMedGoogle Scholar

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© Springer Science+Business Media New York 2004

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  • Adrienne M. Fleckman

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