Summary
Definition
History and exam
Key diagnostic factors
- altered mental status
Other diagnostic factors
- polyuria
- polydipsia
- weight loss
- weakness
- dry mucus membranes
- poor skin turgor
- tachycardia
- hypotension
- seizures
- hypothermia
- shock
- abdominal pain
- focal neurologic signs
Risk factors
- infection
- inadequate insulin or oral antidiabetic therapy
- acute illness in a known patient with diabetes
- nursing home residents
- failure to detect hyperglycemia
- postoperative state
- precipitating medications
- total parenteral nutrition (TPN)
- Cushing syndrome
- hyperthyroidism
- acromegaly
Diagnostic investigations
1st investigations to order
- 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 calcium level
- serum phosphate level
- serum osmolality
- anion gap calculation
- serum lactate level
- blood gas
- urinalysis
- liver function tests
- CBC
Investigations to consider
- chest x-ray
- ECG
- cardiac biomarkers
- blood, urine, or sputum cultures
Treatment algorithm
all patients
HHS resolved and patient able to tolerate oral intake
Contributors
Authors
Guillermo Umpierrez, MD
Professor of Medicine
Emory University School of Medicine
Atlanta
GA
Disclosures
GU is partly supported by research grants from the National Center for Advancing Translational Sciences of the National Institutes of Health, under Award Number UL1TR002378, from the Clinical and Translational Science Award program, and a National Institutes of Health (NIH) grant U30, P30DK11102. GU has also received research grant support to Emory University for investigator-initiated studies from Novo Nordisk, Astra Zeneca, and Dexcom. GU is an author of a number of references cited in this topic.
Peer reviewers
Daniel Morganstein, MBBS, MA (Cantab), MRCP, PhD
Consultant Diabetologist
Beta Cell Unit
Chelsea and Westminster NHS Trust
London
UK
Disclosures
DM declares that he has no competing interests.
M. Cecilia Lansang, MD
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.
Differentials
- Diabetic ketoacidosis (DKA)
- Lactic acidosis
- Alcohol ketoacidosis
More DifferentialsGuidelines
- Standards of medical care in diabetes - 2022
- Diabetic ketoacidosis and hyperglycemic hyperosmolar state
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Diabetes type 2: should I take insulin?
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