Last reviewed: 5 Nov 2021
Last updated: 18 Nov 2021



History and exam

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



Guillermo Umpierrez, MD

Professor of Medicine

Emory University School of Medicine




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




DM declares that he has no competing interests.

M. Cecilia Lansang, MD

Department of Medicine

Division of Endocrinology and Metabolism


University of Florida



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

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