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]

This is the emergency presentation of NIDDMs. [zen104556.zen.co.uk]

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]

Polyuria, polydipsia and weight loss may be present for several days prior to the development of ketoacidosis, while vomiting and abdominal pain are frequently the presenting symptoms. [endocrinologyadvisor.com]

• Fever

  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]

  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]

  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]

  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]

  Fatigue: Because the body can't use glucose for energy properly, kids with hyperglycemia may be unusually tired. [kidshealth.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]

  […] 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]

  […] 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]

  Other clinical or laboratory parameters classically thought to be associated with infection showed no such association in our study: a history of DKA; alcohol abuse; the hemoglobin A 1C value; median temperature; hypothermia or fever at admission; and [academic.oup.com]

  (21 percent). 6 View/Print Table TABLE 2 Precipitating Factors in Hyperosmolar Hyperglycemic State Coexisting diseases Acute myocardial infarction Adrenocorticotropic hormone-producing tumors Cerebrovascular accident Cushing’s syndrome Hyperthermia Hypothermia [aafp.org]

• Malaise

  […] ketosisケトーシス、ケトン症 Kussmaul's breathingク［ー］スマウル［大］呼吸〈糖尿病性大呼吸〉 l ligation 結紮 lipolysis脂肪分解 lipoproteinリポ蛋白［質］、リポプロテイン low-density lipoprotein (LDL)低比重リポ蛋白 luteinizing hormone-releasinghormone (LH-RH)LH放出ホルモン m macular edema (ME)黄斑浮腫 malabsorption吸収不良 malaise [tokyo-med.ac.jp]

  The following are other signs and symptoms of DKA: Malaise, generalized weakness, and fatigability Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia Rapid weight loss in patients newly diagnosed with [emedicine.medscape.com]

• 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]

  Fever due to underlying infection is common, and signs of acidosis (Kussmaul respiration, acetone breath) are usually absent. [endocrinologyadvisor.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]

• 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]

• Tachypnea

  Diagnosis On examination, general findings of DKA may include the following: Ill appearance Dry skin Labored respiration Dry mucous membranes Decreased skin turgor Decreased reflexes Characteristic acetone (ketotic) breath odor Tachycardia Hypotension Tachypnea [emedicine.medscape.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]

  […] 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]

  […] 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]

  […] or abdominal pain (Vomiting can be caused by many illnesses, not just ketoacidosis. [diabetes.org]

  Patients with chronic ethanol abuse with a recent binge culminating in nausea, vomiting and acute starvation may present with alcoholic ketoacidosis. [endocrinologyadvisor.com]

• 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]

  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]

  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]

  Abdominal pain, sometimes mimicking an acute abdomen, is reported in 40-75% of DKA cases. [endocrinologyadvisor.com]

  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]

• 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]

  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]

  […] 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]

• 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]

  Abdominal pain, sometimes mimicking an acute abdomen, is reported in 40-75% of DKA cases. [endocrinologyadvisor.com]

• Ketotic Breath

  Diagnosis On examination, general findings of DKA may include the following: Ill appearance Dry skin Labored respiration Dry mucous membranes Decreased skin turgor Decreased reflexes Characteristic acetone (ketotic) breath odor Tachycardia Hypotension [emedicine.medscape.com]

• 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]

  Physical examination reveals signs of dehydration, including loss of skin turgor, dry mucous membranes, tachycardia and hypotension. [endocrinologyadvisor.com]

• 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]

  Physical examination reveals signs of dehydration, including loss of skin turgor, dry mucous membranes, tachycardia and hypotension. [endocrinologyadvisor.com]

• Confusion

  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]

  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]

  […] 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]

• 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]

  Because phosphate replacement can cause severe hypocalcemia in this setting, serum calcium levels should be monitored closely. 25 Hypomagnesemia may manifest as arrhythmias, muscle weakness, convulsions, stupor, and agitation. [aafp.org]

  Vinik A, Seftel H, Joffe BI (1970) Metabolic findings in hyperosmolar, non-ketotic diabetic stupor. SLancet 2: 797-799. [omicsonline.org]

  Gastrointestinal symptoms such as nausea, vomiting, and/or abdominal pain were present in 98 episodes (79.6%); asthenia was a presenting symptom in 60 (48.7%); neurological symptoms such as altered consciousness, disorientation, or stupor occurred in [academic.oup.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]

  On the other end of the spectrum are the patients brought in for altered mental status and even coma in severe cases. Typical symptoms are those of hyperglycemia, including polyuria and polydipsia, seen in about 75% of patients with DKA. [ahcmedia.com]

  mental status Head MRI: To detect early cerebral edema (order only if altered consciousness is present [1] ) Do not delay administration of hypertonic saline or mannitol in those pediatric cases where cerebral edema is suspected, as many changes may [emedicine.medscape.com]

• Asthenia

  Gastrointestinal symptoms such as nausea, vomiting, and/or abdominal pain were present in 98 episodes (79.6%); asthenia was a presenting symptom in 60 (48.7%); neurological symptoms such as altered consciousness, disorientation, or stupor occurred in [academic.oup.com]

• 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]

  Polyuria, polydipsia and weight loss may be present for several days prior to the development of ketoacidosis, while vomiting and abdominal pain are frequently the presenting symptoms. [endocrinologyadvisor.com]

  Hyperglycaemia will lead to polyuria, dehydration, weight loss, polydipsia and thirst. [diapedia.org]

  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]

• Anuria

  […] hyperglycemia (greater b/c no ketogenesis) which results in profound fluid loss (osmotic diuresis) 2) profound dehydration 3) decreased Na, K and phosphorus As fluid loss continues, eventually hypovolemia occurs: 1) decreased renal perfusion leads to anuria [quizlet.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]

Workup The workup for DKA consists of three parts: establishing the diagnosis, gathering data to direct a treatment plan, and searching for a precipitant. [ahcmedia.com]

See Workup for more detail. [emedicine.medscape.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]

  Similarly, ketonuria clearance also reflects the speed with which insulin needs are met; in our study, ketonuria clearance was slower in the patients with infection, who were more likely not to have complete clearance of ketonuria within 12 h of ICU admission [academic.oup.com]

  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]

• Hyponatremia

  Two patients presented hyponatremia simultaneously. No patients had benefit with phenytoin or diazepam, and one patient got worse after them. Seizure control occurred after insulin and electrolytic treatment. [ncbi.nlm.nih.gov]

  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]

  Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med. 2000;108:180–1. 26. Hillier TA, Abbott RD, Barrett EJ. Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med. 1999;106:399–403. 27. Magee MF, Bhatt BA. [aafp.org]

  High serum osmolarity also drives water from intracellular to extracellular space, causing dilutional hyponatremia. Sodium also is lost in the urine during the osmotic diuresis. [emedicine.medscape.com]

• Hypertriglyceridemia

  Leukocytosis, hypertriglyceridemia, and hyperlipoproteinemia are common. Hyperamylasemia is usually of salivary origin but may suggest a diagnosis of pancreatitis. [accessmedicine.mhmedical.com]

  If the patient has significant hypertriglyceridemia, it can falsely lower glucose and sodium measurements by dilution. Leukocytosis may be present in DKA without infection. [aafp.org]

  Extreme hypertriglyceridemia, which may be present during DKA due to impaired lipoprotein lipase activity, may cause lipemic serum with spurious lowering of serum glucose (pseudonormoglycemia) 23 and serum sodium (pseudohyponatremia) 24 in laboratories [spectrum.diabetesjournals.org]

• Glucagon Increased

  Increased concentration of glucagon lowers the hepatic levels of malonyl coenzyme A (CoA) by blocking the conversion of pyruvate to acetyl CoA through inhibition of acetyl CoA carboxylase, the first rate-limiting enzyme in the novo fatty acid synthesis [endocrinologyadvisor.com]

  In the liver, FFA are oxidized to ketone bodies, a process predominantly stimulated by glucagon. [spectrum.diabetesjournals.org]

• Anion Gap Increased

  These biochemical changes are frequently associated with increased anion gap, increased serum osmolarity and increased serum uric acid. (See Clinical Presentation.) [emedicine.medscape.com]

• Hypocapnia

  Although osmotic factors and other mechanisms may play a part in the development of cerebral edema, recent data suggest that cerebral edema in children with DKA is related to brain ischemia. 42 In children with DKA, both hypocapnia (which causes cerebral [spectrum.diabetesjournals.org]

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]

– 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]

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]

Cerebral edema typically occurs 4-12 hours after treatment is activated, but it can be present before treatment has begun or may develop any time during treatment for DKA. [endocrinologyadvisor.com]

[…] 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]

"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]

Treatment and prognosis Symptoms and imaging findings usually resolve upon normalization of glucose levels 7. [radiopaedia.org]

Coma on admission adversely affects the prognosis. The major causes of death are circulatory collapse, hypokalemia, infection, and cerebral edema. [medical-dictionary.thefreedictionary.com]

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]

Etiology The most common scenarios for diabetic ketoacidosis (DKA) are underlying or concomitant infection (40%), missed or disrupted insulin treatments (25%), and newly diagnosed, previously unknown diabetes (15%). [emedicine.medscape.com]

If the serum osmolality is less than 320 mOsm per kg (320 mmol per kg), etiologies other than DKA should be considered. 3 Osmolality can be calculated using the formula for effective osmolality (mOsm per kg): View/Print Table TABLE 3 Standard Laboratory [aafp.org]

The evolution of diabetic ketoacidosis: An update of its etiology, pathogenesis and management. Metabolism 2016;65:507-521. Ely SF, Neitzel AR, Gill JR. Fatal diabetic ketoacidosis and antipsychotic medication. J Forensic Sci 2013;58:398-403. [ahcmedia.com]

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 - 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]

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]

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]

"Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibria and the effects of theraphy in 37 cases." Medicine 51.2 (1972): 73-94. [derangedphysiology.com]

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]

[…] 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]

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]

To prevent hypokalemia, initiate replacement with intravenous potassium as soon as the serum potassium concentration is below 5.5 mEq/L. [endocrinologyadvisor.com]