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Chapter-016 Glycemic Emergencies: Diabetic Ketoacidosis, Hyperosmolar Nonketotic Hyperglycemia, and Hypoglycemia

BOOK TITLE: ESI Manual of Clinical Endocrinology

Author
1. Chowdhury Subhankar
2. Dutta Deep
ISBN
9789351526476
DOI
10.5005/jp/books/12535_23
Edition
2/e
Publishing Year
2015
Pages
9
Author Affiliations
1. Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India, IPGME & R and SSKM Hospital, Kolkata, West Bengal, India, IPGME and R, Kolkata, West Bengal, India, Institute of Post Graduate Medical Education & Research and SSKM Hospital, Kolkata, West Bengal, India, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
2. PGIMER and Dr RML Hospital, New Delhi, India, Post Graduate Medical Education and Research and Ram Manohar Lohia Hospital, New Delhi, India, Post Graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital, New Delhi, India, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr Ram Manohar Lohia (RML) Hospital, New Delhi, India, Venkateshwar Hospitals, New Delhi, India, Venkateshwar Hospital, New Delhi, India
Chapter keywords
Hyperglycemia, hypoglycemia, diabetic ketoacidosis, hyperosmolar non-ketotic hyperglycemia, leukocytosis, hydration, diabetes, corticosteroids, pentamidine, terbutaline

Abstract

Hyperglycemia and hypoglycemia are the two ends of spectrum in the fluctuations of blood glucose. Diabetic ketoacidosis (DKA) and hyperosmolar non-ketotic hyperglycemia (HNKH) are the glycemic emergencies found in T1DM and T2DM respectively. Both DKA and HNKH are connected with insulinopenia and differ in severity of dehydration, acidosis, and ketosis. Development period of DKA is very rapid and corticosteroids, pentamidine and terbutaline are used to precipitate DKA. Leukocytosis is detected in hyperglycemic emergencies and it is usually proportional to the degree of ketonemia. Hydration is the keystone of management of hyperglycemic and it should be started as soon as possible. Insulin, potassium, bicarbonate and phosphate are essential in the treatment of hyperglycemia. Infection with pneumonia, UTI, meningitis, sepsis and viral disease predominating are the coexisting diseases which can precipitate DKA. HNKH is developed gradually and it can be precipitated by infectious diseases and cardiovascular events. Hypoglycemia dreaded side effect of diabetes. Modalities of diagnosis, treatment, complications and preventions are explained for the above glycemic emergencies.

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