Summary
Definition
História e exame físico
Principais fatores diagnósticos
- altered mental status
Outros fatores diagnósticos
- polyuria
- polydipsia
- weight loss
- weakness
- dry mucous membranes
- poor skin turgor
- tachycardia
- hypotension
- seizures
- hypothermia
- shock
- abdominal pain
- focal neurologic signs
Fatores de risco
- infection
- inadequate insulin or oral antidiabetic therapy
- acute illness in a known patient with diabetes
- nursing home residents
- failure to detect hyperglycemia
- postoperative state
- use of certain drugs
- total parenteral nutrition (TPN)
- Cushing syndrome
- hyperthyroidism
- acromegaly
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- plasma glucose level
- serum or urinary ketone level
- serum BUN level
- serum creatinine level
- serum sodium level
- serum potassium level
- serum chloride level
- serum magnesium level
- serum phosphate level
- serum osmolality
- anion gap calculation
- serum lactate level
- blood gas
- urinalysis
- liver function tests
- CBC
Investigações a serem consideradas
- chest x-ray
- ECG
- cardiac biomarkers
- blood, urine, or sputum cultures
Algoritmo de tratamento
all patients
hyperosmolar hyperglycemic state (HHS) resolved and patient able to tolerate oral intake
Colaboradores
Consultores especialistas
Guillermo Umpierrez, MD
Professor of Medicine
Emory University School of Medicine
Atlanta
GA
Declarações
GU has received research grants from AstraZeneca, Dexcom, and Bayer. GU is an author of a number of references cited in this topic.
Revisores
William B. Horton, MD, MSc, FACP
Assistant Professor of Medicine
University of Virginia School of Medicine
Charlottesville
VA
Declarações
WBH has been a principal investigator for several grants from nonprofit funding sources including the National Institutes of Health, the Juvenile Diabetes Research Foundation, and the American Heart Association. WBH was a contributor to the Diabetes Textbook: Clinical principles, patient management and public health issues, Springer Nature Switzerland AG 2019, having written a chapter about inpatient management of diabetes and hyperglycemia for which he received no fee.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycaemic crises in adults with diabetes: a consensus report. Diabetologia. 2024 Aug;67(8):1455-79.Texto completo Resumo
Mustafa OG, Haq M, Dashora U, et al. Management of hyperosmolar hyperglycaemic state (HHS) in adults: an updated guideline from the Joint British Diabetes Societies (JBDS) for inpatient care group. Diabet Med. 2023 Mar;40(3):e15005.Texto completo Resumo
Diabetes Canada Clinical Practice Guidelines Expert Committee, Goguen J, Gilbert J. Hyperglycemic emergencies in adults. Can J Diabetes. 2018 Apr;42(suppl 1):S109-14.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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