Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • altered mental status

Other diagnostic factors

  • polyuria
  • polydipsia
  • weight loss
  • weakness
  • dry mucous membranes
  • poor skin turgor
  • tachycardia
  • hypotension
  • seizures
  • hypothermia
  • shock
  • abdominal pain
  • focal neurological signs

Risk factors

  • infection
  • inadequate insulin or oral antiglycaemic therapy
  • acute illness in a known patient with diabetes
  • older nursing home residents
  • postoperative state
  • precipitating medications
  • total parenteral nutrition (TPN)
  • Cushing's syndrome
  • hyperthyroidism
  • acromegaly

Diagnostic investigations

1st investigations to order

  • plasma glucose level
  • serum or urinary ketone level
  • serum urea level
  • serum creatinine level
  • serum sodium level
  • serum potassium level
  • serum chloride level
  • serum magnesium level
  • serum calcium level
  • serum phosphate level
  • serum osmolality
  • anion gap calculation
  • serum lactate level
  • blood gas
  • urinalysis
  • LFTs
  • FBC
Full details

Investigations to consider

  • CXR
  • ECG
  • myocardial enzymes
  • blood, urine, or sputum cultures
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Endocrinologist

Joslin Diabetes Clinic

Boston

MA

Disclosures

NK declares that she has no competing interests.

Professor of Medicine

Emory University School of Medicine

Atlanta

GA

Disclosures

GU is supported by research grants from the American Diabetes Association and the National Institutes of Health, and has received research funds from Sanofi-Aventis, Novo Nordisk, Takeda, and GlaxoSmithKline. GU is an author of a number of references cited in this monograph.

Peer reviewers VIEW ALL

Consultant Diabetologist

Beta Cell Unit

Chelsea and Westminster NHS Trust

London

UK

Disclosures

DM declares that he has no competing interests.

Department of Medicine

Division of Endocrinology and Metabolism

Gainesville

University of Florida

FL

Disclosures

MCL has received speaker fees from Sanofi-Aventis and Novo Nordisk, makers of insulin products.

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