Resumo
Definição
History and exam
Key diagnostic factors
- alteración del estado mental
Other diagnostic factors
- poliuria
- polidipsia
- pérdida de peso
- debilidad
- sequedad de mucosas
- turgencia cutánea reducida
- taquicardia
- hipotensión
- convulsiones
- hipotermia
- shock
- dolor abdominal
- signos neurológicos focales
Risk factors
- infección
- tratamiento inadecuado con insulina o antidiabéticos orales
- enfermedad aguda en un paciente con diabetes conocida
- residentes de residencias de ancianos
- incapacidad para detectar la hiperglucemia
- estado postoperatorio
- medicamentos desencadenantes
- nutrición parenteral total (NPT)
- Síndrome de Cushing
- hipertiroidismo
- acromegalia
Diagnostic tests
1st tests to order
- nivel de glucosa plasmática
- nivel de cetona sérica o urinaria
- nivel de urea sérica
- nivel de creatinina sérica
- nivel de sodio sérico
- nivel de potasio sérico
- nivel de cloruro sérico
- nivel de magnesio sérico
- nivel de calcio sérico
- nivel de fosfato sérico
- osmolalidad sérica
- cálculo de la brecha aniónica
- nivel de lactato sérico
- gas en sangre
- análisis de orina
- pruebas de función hepática
- hemograma completo (HC)
Tests to consider
- radiografía de tórax
- electrocardiograma (ECG)
- biomarcadores cardíacos
- hemocultivos, urocultivos o cultivos de esputo
Treatment algorithm
todos los pacientes
síndrome hiperosmolar hiperglucémico (SHH) resuelto y paciente capaz de tolerar ingesta oral
Contributors
Authors
Guillermo Umpierrez, MD
Professor of Medicine
Emory University School of Medicine
Atlanta
GA
Disclosures
GU has received research grants from Astra Zeneca, Dexcom, and Bayer. 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.
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.
References
Key articles
Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycaemic crises in adults with diabetes: a consensus report. Diabetologia. 2024 Aug;67(8):1455-79.Full text Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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- Cetoacidosis diabética (CAD)
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