Summary
Definition
History and exam
Other diagnostic factors
- poliúria
- polifagia
- polidipsia
- perda de peso
- fraqueza
- náuseas ou vômitos
- dor abdominal
- membranas mucosas ressecadas
- turgor cutâneo diminuído
- olhos encovados
- taquicardia
- hipotensão
- respiração de Kussmaul
- hálito cetônico
- estado mental alterado
- hipotermia
Risk factors
- diabetes do tipo 1
- insulinoterapia inadequada ou inapropriada
- infecção
- infarto do miocárdio
- episódio anterior de hipoglicemia ou crise hipoglicêmica
- hemoglobina A1c (HbA1c) elevada
- determinantes sociais adversos da saúde
- Idade <45 anos
- presença de outras complicações relacionadas à diabetes
- presença de outras condições crônicas de saúde
- pancreatite
- acidente vascular cerebral (AVC)
- acromegalia
- hipertireoidismo
- uso de determinados medicamentos
- Síndrome de Cushing
- Ascendência hispânica, asiática ou negra
- cirurgia bariátrica
- jejum prolongado ou restrição de carboidratos
- gestação
- demência
- transtornos de saúde mental
- uso de álcool e/ou substâncias
Diagnostic investigations
1st investigations to order
- glicose plasmática
- gasometria arterial
- cetonas capilares ou séricas
- urinálise
- ureia sérica
- creatinina sérica
- sódio sérico
- potássio sérico
- cloreto sérico
- magnésio sérico
- fosfato sérico
- cálculo do anion gap
- lactato sérico
- testes da função hepática
- amilase sérica
- lipase sérica
- osmolalidade sérica
- Hemograma completo
- eletrocardiograma (ECG)
Investigations to consider
- creatina quinase (CK) sérica
- radiografia torácica
- troponina cardíaca de alta sensibilidade
- culturas de sangue, urina ou escarro
Treatment algorithm
Contributors
Authors
Aidar R. Gosmanov, MD, PhD, FACE
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.
Laleh Razavi Nematollahi, MD
Assistant Professor of Medicine
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University
Cleveland
OH
Disclosures
LRN declares that she has no competing interests.
Acknowledgements
Dr Aidar Gosmanov and Dr Laleh Razavi Nematollahi would like to gratefully acknowledge Professor Abbas E. Kitabchi, the previous contributor to this topic.
Disclosures
AEK is an author of a number of references in this topic.
Peer reviewers
David Jenkins, DM, FRCP
Consultant Physician
Worcestershire Royal Hospital
Worcester
UK
Disclosures
DJ declares that he has no competing interests.
Udaya M. Kabadi, MD, FRCP(C), FACP, FACE
Professor of Medicine
University of Iowa
Iowa City
IA
Disclosures
UMK declares that she has no competing interests.
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
American Diabetes Association. Standards of care in diabetes - 2025. Diabetes Care. 2025 Jan ;48(suppl 1):S1-352.Full text
Dhatariya KK, Glaser NS, Codner E, et al. Diabetic ketoacidosis. Nat Rev Dis Primers. 2020 May 14;6(1):40. Abstract
Umpierrez G, Korytkowski M. Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol. 2016 Apr;12(4):222-32. Abstract
Reference articles
A full list of sources referenced in this topic is available here.
O uso deste conteúdo está sujeito ao nosso aviso legal