Last reviewed: June 2020
Last updated: February  2020

Summary

Definition

History and exam

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
  • myocardial infarction 
  • pancreatitis
  • stroke
  • acromegaly
  • hyperthyroidism
  • drugs (e.g., corticosteroids, thiazides, pentamidine, sympathomimetics, second-generation antipsychotics, cocaine, immune checkpoint inhibitors, or SGLT-2 inhibitors)
  • Cushing syndrome
  • Hispanic or black ancestry
  • bariatric surgery

Diagnostic investigations

1st investigations to order

  • plasma glucose
  • ABG
  • capillary or serum ketones
  • urinalysis
  • serum BUN
  • 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
  • CBC
More 1st investigations to order

Investigations to consider

  • chest x-ray
  • ECG
  • cardiac biomarkers
  • blood, urine, or sputum cultures
More investigations to consider

Treatment algorithm

Contributors

Associate Professor of Medicine

Division of Endocrinology

Albany Medical College 

Chief, Endocrinology Section

Albany VAMC

Albany

NY

Disclosures

ARG declares that he has no competing interests.

Assistant Professor of Medicine

Case Western Reserve University

Cleveland

OH 

Disclosures

LRN declares that she has no competing interests.

Dr Aidar Gosmanov and Dr Laleh Razavi Nematollahi would like to gratefully acknowledge Professor Abbas E. Kitabchi, the previous contributor to this topic.

Peer reviewersVIEW 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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