Edit concept Question Editor Create issue ticket

Diabetic Ketotic Coma


Presentation

  • This is the emergency presentation of NIDDMs.[zen104556.zen.co.uk]
  • The moderate level of IRI (14 microU/ml) on admission and a good response to glucagon 2 months after admission also indicate that the present case is a typical hyperosmolar non-ketotic coma.[ncbi.nlm.nih.gov]
  • Diabetic hyperosmolar coma Diabetic ketoacidosis Causes - 20% cases initial presentation of DM - failure to take insulin (Type I DM) - infection - sterile inflammation eg MI - excessive physical activity Clinical features Symptoms - when history available[aic.cuhk.edu.hk]
  • Sizemore Lippincott Williams & Wilkins, 2007 - 292 من الصفحات This pocket-sized quick-reference handbook presents evidence-based recommendations for diagnosis and treatment of endocrine disorders.[books.google.com]
  • Delays in diagnosis and management of glycaemic emergencies presenting as a constellation of neurological abnormalities can be avoided by routine early measurement of blood glucose.[ncbi.nlm.nih.gov]
Fever
  • The features include hyperglycemic hyperosmolar coma complicated by a malignant hyperthermia-like picture with fever, rhabdomyolysis, and severe cardiovascular instability. Design. Case series. Setting.[pediatrics.aappublications.org]
  • The exam may show that you have: Extreme dehydration Fever higher than 100.4 F (38 C) Increased heart rate Low systolic blood pressure Test that may be done include: Blood osmolarity (concentration) BUN and creatinine levels Blood sodium level (needs[mountsinai.org]
  • Fever and abdominal tenderness may also be present. Laboratory evaluation reveals hyperglycemia, ketosis (β-hydroxybutyrate acetoacetate), and metabolic acidosis (arterial pH 6.8–7.3) with an increased anion gap ( Table 24-1 ).[accessmedicine.mhmedical.com]
Fatigue
  • […] and Charaachiness Stage 3 Ketones in the Urine (ketonuria) Thirst, urination, plus more significant fatigue, headache/body aches, and possible nausea Stage 4 Diabetic Ketoacidosis (DKA) Same as above, plus vomiting, discomfort, confusion, dizziness,[insulinnation.com]
  • Symptoms frequently none, fatigue, recurrent infections. Ketosis resistant except during infection or stress.[quizlet.com]
  • The affected person may also experience symptoms such as rapid breathing, shortness of breath, a fruity scent to the breath, nausea, vomiting, fatigue, confusion, and eventually coma.[labtestsonline.org]
  • "Symptoms also include fruity breath, nausea, vomiting, fatigue, flu-like symptoms, difficulty breathing and eventually coma," said Sylvia White, R.D., C.D.E., diabetes educator and owner of ParentingDiabetes.com .[eatingwell.com]
  • We report on a case of a 56-year-old white woman with unknown diabetes who was admitted to the emergency department because of fever, chills, arthromyalgia, and fatigue. At presentation, she was confused, lethargic, and dehydrated.[care.diabetesjournals.org]
Hypothermia
  • .), impaired mentation, hypothermia Etiology – DKA is due to loss of insulin, which directly causes hyperglycemia and high ketone bodies Note: insulin does not directly cause acidosis – ketone bodies are weak acids, so acidosis is secondary to hyperketosis[d3jonline.tripod.com]
  • […] mmol/L–US: 600 mg/dL, ketone bodies, relative in protein, albumin, Ca2 , BR, alk phos, AST, CK, anion gap, acidosis, dehydration, K , Na , phosphate Management Insulin, fluid and electrolyte replacement, treat initiating factors–eg, leukocytosis or hypothermia[medical-dictionary.thefreedictionary.com]
  • […] illness Infection (32 – 60%) Pneumonia Urinary tract infection Sepsis Cerebrovascular accident Myocardial infarction Acute pancreatitis Acute pulmonary embolus Intestinal obstruction Dialysis, peritoneal Mesenteric thrombosis Renal failure Heat stroke Hypothermia[diabetesincontrol.com]
  • The presence of coma at presentation, hypothermia or persistent oliguria are poor prognostic indicators. Cerebral oedema remains the most common cause of mortality, particularly in young children and adolescents.[patient.info]
Kussmaul Respiration
  • […] gap acidosis State of hyperosmolality with low or no ketone bodies Cause Excessive synthesis of ketone bodies from free fatty acids Severe hyperglycemia due to insufficient insulin resulting in plasma hyperosmolality and excessive water loss Symptoms Kussmaul[howmed.net]
  • Classic signs of DKA include Kussmaul respirations and an acetone odor on the pt's breath. Volume depletion can lead to dry mucous membranes, tachycardia, and hypotension. Fever and abdominal tenderness may also be present.[accessmedicine.mhmedical.com]
  • Respiratory compensation of acidosis can lead to tachypnoea or Kussmaul respiration (very deep, slowly rhythmic breathing). Examine the chest for signs of pneumonic consolidation.[patient.info]
  • Respiration (increased tidal volume) fruity, acetone odor severely dehydrated cerebral edema associated with high mortality in pediatric patients Evaluation Diagnostic criteria blood glucose levels 250 mg/dL Arterial pH 7.3 expect to see an increase[medbullets.com]
  • respirations, 7) acetone noted on breath (fruity); 1) glucose 250, 2) arterial blood pH 7.3, 3) serum HCO3 16, 4) moderate to large ketones in urine/blood. 5) high anion gap (normal 8-12 mEq/L) Anion Gap: Relationship to Metabolic Acidosis Formula is[quizlet.com]
Hyperpnea
  • Inpatient care after an episode of ketoacidosis is the same as for diabetes mellitus. diabetic ketoacidosis A hyperglycemia-induced clinical crisis most common in type 1 DM Clinical N&V, thirst, diaphoresis, hyperpnea, drowsiness, fever, prostration,[medical-dictionary.thefreedictionary.com]
Vomiting
  • […] or no ketone bodies Cause Excessive synthesis of ketone bodies from free fatty acids Severe hyperglycemia due to insufficient insulin resulting in plasma hyperosmolality and excessive water loss Symptoms Kussmaul respiration, acetone breath, nausea, vomiting[howmed.net]
  • […] presentation of DM - failure to take insulin (Type I DM) - infection - sterile inflammation eg MI - excessive physical activity Clinical features Symptoms - when history available varies from a few weeks to a few days - osmotic symptoms - anorexia - vomiting[aic.cuhk.edu.hk]
  • […] osmotic diuresis (from hyperglycemia) causes polyuria/polydipsia, systemic dehydration, and hypotension hyperkalemia (from hyperglycemia and acidosis) causes tachycardia, abdominal pain (ileus), gastric stasis, and leg cramps ketosis causes nausea and vomiting[d3jonline.tripod.com]
  • […] or abdominal pain (Vomiting can be caused by many illnesses, not just ketoacidosis.[diabetes.org]
Nausea
  • […] with low or no ketone bodies Cause Excessive synthesis of ketone bodies from free fatty acids Severe hyperglycemia due to insufficient insulin resulting in plasma hyperosmolality and excessive water loss Symptoms Kussmaul respiration, acetone breath, nausea[howmed.net]
  • […] glucose osmotic diuresis (from hyperglycemia) causes polyuria/polydipsia, systemic dehydration, and hypotension hyperkalemia (from hyperglycemia and acidosis) causes tachycardia, abdominal pain (ileus), gastric stasis, and leg cramps ketosis causes nausea[d3jonline.tripod.com]
  • Since severe ketosis will likely make a person extremely nauseas in addition to their illness-induced nausea, it can be nearly impossible to consume enough fluids at home to re-hydrate the body.[diabetesdaily.com]
  • Symptoms of HONK Before loss of consciousness and coma takes place, patients will display signs of very high blood sugar levels which may include: Extreme thirst Frequent need to urinate Disorientation Nausea The condition of very high blood glucose without[diabetes.co.uk]
  • Nausea, vomiting and severe abdominal cramps. Blurred vision Fruity or pungent smelling breath due to the presence of acetone and ketones in the breath.[news-medical.net]
Abdominal Pain
  • pain Mental confusion, DehydrationComa Lab Investigations Plasma glucose Serum Urea Serum creatinine Serum ketones Serum electrolytes Plasma Osmolality Urine analysis (ketones) ABG analysis Complete blood count with differentiatials HbA1c Plasma glucose[howmed.net]
  • pain (ileus), gastric stasis, and leg cramps ketosis causes nausea and vomiting acidosis causes tachycardia, rapid deep breathing (Kussmaul), hypotension(vasodil.), impaired mentation, hypothermia Etiology – DKA is due to loss of insulin, which directly[d3jonline.tripod.com]
  • Snap Shot A 12 year old boy, previously healthy, is admitted to the hospiral after 2 days of polyuria, polyphagia, nausea, vomting and abdominal pain. Temp is 37, BP 103/63, HR 112, RR 30. Physical exam shows a lethargic boy.[medbullets.com]
  • Here, alcohol metabolism combined with little to no glycogen reserves causes ketone bodies to increase to dangerous levels, resulting in dehydration, abdominal pain, nausea and vomiting. Follow Joseph Castro on Twitter .[livescience.com]
Polydipsia
  • […] not been previously diagnosed poor prognostic factors : age (65 or older), extreme acidosis (pH Signs and Symptoms – many gastric symptoms, probably protective against further ingestion of glucose osmotic diuresis (from hyperglycemia) causes polyuria/polydipsia[d3jonline.tripod.com]
  • Hyperglycemia: Manifestations manifests as 1) polyuria: osmotic diuresis (glucose in renal tubules cannot be reabsorbed; consequent hyperosmolarity and osmotic pressure results in more water in tubules) 2) polyphagia followed by lack of appetite, 3) polydipsia[quizlet.com]
  • […] which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced.This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia[intensivecarehotline.com]
  • Hyperglycaemia will lead to polyuria, dehydration, weight loss, polydipsia and thirst.[diapedia.org]
  • DKA typically presents with polyuria and polydipsia, vomiting, dehydration and, if severe, an altered mental state, including coma.[patient.info]
Acute Abdomen
  • Acidosis may rarely cause abdominal pain and simulate a surgical acute abdomen. The typical smell of acetone can be detected in the patient's breath, although some people are unable to detect this smell.[diapedia.org]
  • Acute abdomen. Ketoacidosis due to starvation. Investigations Capillary blood glucose (remember to send a plasma glucose also). Urine dipstick testing shows marked glycosuria and ketonuria (also send urine for microscopy and culture).[patient.info]
Hypotension
  • […] hyperkalemia (from hyperglycemia and acidosis) causes tachycardia, abdominal pain (ileus), gastric stasis, and leg cramps ketosis causes nausea and vomiting acidosis causes tachycardia, rapid deep breathing (Kussmaul), hypotension(vasodil.), impaired[d3jonline.tripod.com]
  • Hypotension also results in impaired tissue perfusion. Coma is the end stage of this hyperglycemic process, when severe electrolyte disturbances occur in association with hypotension.[emedicine.medscape.com]
  • Volume depletion can lead to dry mucous membranes, tachycardia, and hypotension. Fever and abdominal tenderness may also be present.[accessmedicine.mhmedical.com]
  • […] impairs protein synthesis and causes protein degradation, resulting in nitrogen losses (amino acids contain NH2) 1) EARLY: may present as lethargy, weakness 2) dehydration resulting in poor skin turgor, dry mucous membranes, 3) tachycardia, 4) orthostatic hypotension[quizlet.com]
  • Hypotension. Check temperature, pulse and blood pressure. Smell the breath for the characteristic fruity/musty odour of ketones - the smell is akin to pear drops or nail-polish remover.[patient.info]
Tachycardia
  • , abdominal pain (ileus), gastric stasis, and leg cramps ketosis causes nausea and vomiting acidosis causes tachycardia, rapid deep breathing (Kussmaul), hypotension(vasodil.), impaired mentation, hypothermia Etiology – DKA is due to loss of insulin,[d3jonline.tripod.com]
  • Volume depletion can lead to dry mucous membranes, tachycardia, and hypotension. Fever and abdominal tenderness may also be present.[accessmedicine.mhmedical.com]
  • […] alcohol intake without food, 2) too little food or skipping meals 3) too much diabetic medication 4) too much exercise, 5) mismatch of medications and food, 6) weight loss without medication adjustment, Hypoglycemia: Manifestations MILD: sweating, tremor, tachycardia[quizlet.com]
  • Electrolyte disturbances result from loss of water usually in excess of salt loss; hypovolaemia and severe intravascular dehydration will be accompanied by tachycardia and may give rise to thromboembolic complications (such as stroke or myocardial infarction[diapedia.org]
  • Tachycardia with weak pulse. Hypotension. Check temperature, pulse and blood pressure. Smell the breath for the characteristic fruity/musty odour of ketones - the smell is akin to pear drops or nail-polish remover.[patient.info]
Osteoporosis
  • This thoroughly updated edition features a new chapter on genetics, expanded chapters on lipids and obesity and nutrition, and comprehensive coverage of new therapies for diabetes and osteoporosis.[books.google.com]
  • Updated clinical guidelines for diabetes, lipid disorders, obesity management, osteoporosis, and more, as well as essential treatment updates for the medical management of acromegaly, Cushing's Disease, hypercalcemia, and diabetes mellitus.[books.google.it]
Polyuria
  • […] diabetes had not been previously diagnosed poor prognostic factors : age (65 or older), extreme acidosis (pH Signs and Symptoms – many gastric symptoms, probably protective against further ingestion of glucose osmotic diuresis (from hyperglycemia) causes polyuria[d3jonline.tripod.com]
  • The initial symptoms of DKA include anorexia, nausea, vomiting, polyuria, and thirst. Abdominal pain, altered mental function, or frank coma may ensue. Classic signs of DKA include Kussmaul respirations and an acetone odor on the pt's breath.[accessmedicine.mhmedical.com]
  • Hyperglycaemia will lead to polyuria, dehydration, weight loss, polydipsia and thirst.[diapedia.org]
  • Polyuria — Excessive secretion of urine. Type I diabetes — Also called juvenile diabetes. Type I diabetes typically begins early in life. Affected individuals have a primary insulin deficiency and must take insulin injections.[medical-dictionary.thefreedictionary.com]
  • […] too little diabetic medications, 3) inactivity, 4) emotional/physical stress, 5) poor absorption of insulin 6) illness 7) corticosteroids **counterregulatory hormones released when stress, illness persist Hyperglycemia: Manifestations manifests as 1) polyuria[quizlet.com]
Confusion
  • Hyperosmolar diabetic non-ketotic coma is a metabolic emergency usually seen in elderly non-insulin dependent diabetics, characterized by severe hyperglycaemia, volume depletion, altered consciousness, confusion and less frequently neurological deficit[ncbi.nlm.nih.gov]
  • Excessive synthesis of ketone bodies from free fatty acids Severe hyperglycemia due to insufficient insulin resulting in plasma hyperosmolality and excessive water loss Symptoms Kussmaul respiration, acetone breath, nausea, vomiting, abdominal pain Mental confusion[howmed.net]
  • […] not lost because there are very few negative ketones whose charge needs balancing by excretion of sodium; any acidosis is being compensated for with sodium retention and hydrogen ion loss hypernatraemia dehydration - intense thirst weight loss mental confusion[zen104556.zen.co.uk]
  • Vomiting particularly useful as a warning in known diabetic - abdo pain (uncommon): dull persistent discomfort often affecting whole abdomen but usually centred on the umbilicus Signs 3 cardinal signs: dehydration overbreathing ketones on breath Others: confusion[aic.cuhk.edu.hk]
Lethargy
  • Nonketotic hyperosmolar coma [ edit ] Nonketotic hyperosmolar coma usually develops more insidiously than diabetic ketoacidosis because the principal symptom is lethargy progressing to obtundation, rather than vomiting and an obvious illness.[en.wikipedia.org]
  • Symptoms of ketoacidosis Symptoms of ketoacidosis are: extreme thirst lethargy frequent urination (due to high blood glucose levels) nausea vomiting abdominal pain progressive drowsiness deep, rapid breathing a fruity or acetone smell on the breath.[betterhealth.vic.gov.au]
  • Possibilities include headache, lethargy, irritability , leg cramps , constipation and heart palpitations . These side effects are usually relatively minor and transient, and most of them can be avoided by getting enough fluid and salt .[dietdoctor.com]
  • Some common DKA symptoms include: high blood sugar levels frequent urination (polyuria) and thirst fatigue and lethargy nausea vomiting abdominal pain fruity odor to breath rapid, deep breathing muscle stiffness or aching coma Diagnosis Diagnosis requires[medical-dictionary.thefreedictionary.com]
  • […] hydrogen ions. 4) As hypoxia worsens lactic acid builds up contributing to the acidosis. 5) insulin deficiency impairs protein synthesis and causes protein degradation, resulting in nitrogen losses (amino acids contain NH2) 1) EARLY: may present as lethargy[quizlet.com]
Altered Mental Status
  • Both disorders are associated with absolute or relative insulin deficiency, volume depletion, and altered mental status. The metabolic similarities and differences in DKA and HHS are summarized in Table 24-1.[accessmedicine.mhmedical.com]
  • Blood glucose level Serum osmolarity Generally, hyperosmolar hyperglycemic state is initially suspected when a markedly elevated glucose level is found in a fingerstick specimen obtained in the course of a workup of altered mental status.[merckmanuals.com]
Stupor
  • Typically, the patient, a middle-aged or old person with diabetes mellitus of recent onset or without previous history of the disease, lapses into stupor and unconsciousness after manifesting prodromal neurological symptoms, such as convulsions, aphasia[jamanetwork.com]
  • Vinik A, Seftel H, Joffe BI (1970) Metabolic findings in hyperosmolar, non-ketotic diabetic stupor. SLancet 2: 797-799.[omicsonline.org]

Workup

  • Blood glucose level Serum osmolarity Generally, hyperosmolar hyperglycemic state is initially suspected when a markedly elevated glucose level is found in a fingerstick specimen obtained in the course of a workup of altered mental status.[merckmanuals.com]
Ketonuria
  • Because of a preferential increase in 3-OHBA, ketonuria seemed to be absent in the regular nitroprusside test.[ncbi.nlm.nih.gov]
  • Initially high anion gap but as ketones excreted becomes normal anion gap acidosis - hyperkalaemia usual, but hypokalaemia possible - features of dehydration - glycosuria and ketonuria while urine flow adequate - ECG - CXR - cultures - FBC Treatment General[aic.cuhk.edu.hk]
  • However, when there is excessive ketone accumulation, it is excreted in the urine, leading to ketonuria. If not treated promptly, this results in metabolic acidosis or ketoacidosis.[healthhype.com]
  • DKA is characterised by hyperglycaemia, acidosis and ketonaemia: [ 1 ] Ketonaemia (3 mmol/L and over), or significant ketonuria (more than 2 on standard urine sticks).[patient.info]
  • Stages Characteristics Symptoms Stage 1 Rising blood sugar (due to one of the reasons listed above) Thirst, urination, low energy Stage 2 Ketones in the blood stream (ketosis) Thirst, urination, fatigue and Charaachiness Stage 3 Ketones in the Urine (ketonuria[insulinnation.com]
Hyponatremia
  • Hyperglycemia may cause dilutional hyponatremia, so measured serum sodium is corrected by adding 1.6 mEq/L (1.6 mmol/L) for each 100 mg/dL (5.6 mmol/L) elevation of serum glucose over 100 mg/dL (5.6 mmol/L).[merckmanuals.com]
  • Review Topic QID: 109465 1 Hyponatremia is independently associated with a poor prognosis 2 Hyperkalemia is independent of the patient's total body potassium stores 3 Hyperglycemia to this magnitude supports hyperglycemic hyperosmolar nonketotic syndrome[medbullets.com]
Hypertriglyceridemia
  • Leukocytosis, hypertriglyceridemia, and hyperlipoproteinemia are common. Hyperamylasemia is usually of salivary origin but may suggest a diagnosis of pancreatitis.[accessmedicine.mhmedical.com]

Treatment

  • Make the best clinical decisions with an enhanced emphasis on evidence-based practice and expert opinions on treatment strategies. Zero in on the most relevant and useful references with the aid of a more focused, concise bibliography.[books.google.it]
  • What Are The Treatment Of Diabetes Mellitus Lisinopril Diabetes : What Are The Treatment Of Diabetes Mellitus : Fast Online Service Exposicin Diabetes Mellitus 2.[ipmgroup.eu]
  • 545 Dialysis ultrafiltration and hemofiltration 555 Use of drugs in uremia and dialysis 567 Donor and recipient selection in renal transplantation 587 Immunosuppression and treatment of rejection in renal transplantation 595 XIII 606 Renal tubular and[books.google.it]
  • – b -sympathomimetic agents bolster catecholamines, which can tip the balance Treatment of DKA (1) fluids (saline) – normal perfusion of lung and kidney is necessary to eliminate glucose, ketones, and acid lungs – hyperventilation alkalizes blood and[d3jonline.tripod.com]
  • Treatment of acute hyperkalaemia includes calcium ions, insulin with dextrose, salbutamol and haemodialysis.[ncbi.nlm.nih.gov]

Prognosis

  • […] acute phase shift treatment to diet or oral drugs eg sulphonylureas or biguanides 3) Prevent arterial thrombosis with s.c. heparin if at risk of GI bleeding or i.v. heparin if not at risk 4) Stop potential precipitating factors eg diuretics or phenytoin Prognosis[zen104556.zen.co.uk]
  • Treatment and prognosis Symptoms and imaging findings usually resolve upon normalization of glucose levels 7.[radiopaedia.org]
  • "Course and prognosis of 132 patients with diabetic non ketotic hyperosmolar state." Diabete & metabolisme 20.1 (1993): 43-48. Gouveia, Catherine F., and Tahseen A. Chowdhury.[derangedphysiology.com]
  • Coma on admission adversely affects the prognosis. The major causes of death are circulatory collapse, hypokalemia, infection, and cerebral edema.[medical-dictionary.thefreedictionary.com]

Etiology

  • .), impaired mentation, hypothermia Etiology – DKA is due to loss of insulin, which directly causes hyperglycemia and high ketone bodies Note: insulin does not directly cause acidosis – ketone bodies are weak acids, so acidosis is secondary to hyperketosis[d3jonline.tripod.com]
  • The underlying etiology of this syndrome remains unclear.[pediatrics.aappublications.org]

Epidemiology

  • Epidemiology - 10/100 000/yr - 6 times less common than DKA - 30% previously undiagnosed diabetics Clinical features - more common in elderly - onset insidious - infection, intercurrent cardiovascular disease, steroids, diuretics and intake of glucose[aic.cuhk.edu.hk]
  • ., only ketoacidosis can cause all three symptoms Epidemiology – DKA accounts for 1.6% of all hospital admissions and accounts for 10% of all diabetes-related deaths in 20% of DKA admissions, diabetes had not been previously diagnosed poor prognostic[d3jonline.tripod.com]
  • Epidemiology of acute manifestations and complications.[diabetesincontrol.com]
  • Epidemiology of the Hyperglycaemic Hyperosmolar State HHS principally affects those with type 2 diabetes, either as the first presentation of the disease or in those with poor compliance to medication.[diapedia.org]
  • However, hyperglycaemia may not always be present and low blood ketone levels ( [ 2 ] Epidemiology DKA is normally seen in people with type 1 diabetes.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Each disease-oriented section begins with an up-to-date review of pathophysiology and then focuses on specific diseases.[books.google.it]
  • Clinical features, pathophysiology, renal function, acid-base balance, plasma cerebrospinal fluid equilibria and the effects of therapy in 37 cases. Medicine (Baltimore) 51, 73–94. CrossRef Google Scholar Coghlan, J. D. 1981.[link.springer.com]
  • Beside this pessimistic development of the pathophysiology of coma in DKA there are also more optimistic aspects.[omicsonline.org]
  • Pathophysiology Although DKA can occur in patients with type 2 diabetes, it mainly develops in people with type 1 diabetes who need to take insulin for their condition. If individuals do not receive insulin, they will develop DKA.[news-medical.net]
  • The exact underlying pathophysiology of changes seen on imaging of patients with non-ketotic hyperglycemic hemichorea is not fully understood 1,2.[radiopaedia.org]

Prevention

  • Stroke / DVT / PE / mesenteric artery thrombosis NB These patients are NOT ketotic or acidotic - this is because the insulin level, while not high enough to prevent hyperglycaemia or liver gluconeogenesis, is enough to prevent lipolysis; therefore ketones[zen104556.zen.co.uk]
  • Marked dehydration is thought to cause renal dysfunction, and the increase in ADH may have helped to prevent further aggravation of ketoacidosis.[ncbi.nlm.nih.gov]
  • […] ketone bodies (2) insulin – turn off gluconeogenesis/glycogenolysis [K ] must be carefully monitored, since insulin causes K to enter cells – hyperkalemia Þ hypokalemia (3) do NOT use alkali – unless pH 7.0 (4) find and treat the precipitating factor to prevent[d3jonline.tripod.com]
  • . , et al ( 1986 ) Frequency and prevention of neuroleptic malignant syndrome in a large psychiatric hospital . American Journal of Psychiatry , 143 , 1227 – 1233 . Smego , R. A. & Durack , D. T. ( 1982 ) The neuroleptic malignant syndrome .[bjp.rcpsych.org]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!