Last reviewed: October 2018
Last updated: August  2018

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors

Other diagnostic factors

  • polyuria
  • polyphagia
  • polydipsia
  • weight loss
  • weakness
  • nausea or vomiting
  • abdominal pain
  • dry mucous membranes
  • poor skin turgor
  • sunken eyes
  • tachycardia
  • hypotension
  • Kussmaul respiration
  • acetone breath
  • altered mental status
  • hypothermia

Risk factors

  • inadequate or inappropriate insulin therapy
  • infection
  • MI
  • pancreatitis
  • stroke
  • acromegaly
  • hyperthyroidism
  • drugs such as corticosteroids, thiazides, pentamidine, sympathomimetics, second-generation antipsychotics, cocaine, immune checkpoint inhibitors, or SGLT2 inhibitors
  • Cushing's syndrome
  • Hispanic or black ancestry
  • bariatric surgery

Diagnostic investigations

1st investigations to order

  • plasma glucose
  • ABG
  • capillary or serum ketones
  • urinalysis
  • serum urea
  • serum creatinine
  • serum sodium
  • serum potassium
  • serum chloride
  • serum magnesium
  • serum calcium
  • serum phosphate
  • anion gap calculation
  • serum creatine phosphokinase
  • serum lactate
  • LFT
  • serum amylase
  • serum lipase
  • serum osmolality
  • FBC
Full details

Investigations to consider

  • chest x-ray
  • ECG
  • cardiac biomarkers
  • blood, urine, or sputum cultures
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Associate Professor of Medicine

Division of Endocrinology

Albany Medical College

and

Chief, Endocrinology Section

Albany VAMC

Albany

NY

Disclosures

ARG declares that he has no competing interests.

Dr Aidar Gosmanov would like to gratefully acknowledge Professor Abbas E. Kitabchi and Dr Laleh Razavi Nematollahi, the previous contributors to this topic. AEK is an author of a number of references in this topic and LRN declares that she has no competing interests.

Peer reviewers VIEW ALL

Consultant Physician

Worcestershire Royal Hospital

Worcester

UK

Disclosures

DJ declares that he has no competing interests.

Professor of Medicine

University of Iowa

Iowa City

IA

Disclosures

UMK declares that she has no competing interests.

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