Hyperglycemic Crisis in Adults: Pathophysiology,
Editor’s note: This article is the 9th in a 12-part series reviewing the funda-mentals of diabetes care for physicians in training. Previous articles in the series can be viewed at the Clinical
Diabetes website (http://clinical.water and the flow is incessant . . . . Life is short, unpleasant and painful, thirst unquenchable, drinking exces-sive . . . . If for a while they abstain from drinking, their mouths become parched and their bodies dry; the viscera seem scorched up: the patients are affected by nausea, restlessness and a burning thirst, and within a Pathophysiology
CliniCal Diabetes • Volume 27, Number 1, 2009
2 diabetic patients > 50 years of age,
Grave’s disease or Hashitoxicosis.8–10
Presentation
Volume 27, Number 1, 2009 • CliniCal Diabetes
Treatment
falls to < 5.3 mEq/l. Including 20–30
diac disease, initial fluid resuscitation
restore renal perfusion. Typical initial
tion is restored to > 3.3 mEq/l. This
initial fluid bolus. Titration of fluids is
in patients with a pH > 7.0. Its use,
patients with an arterial pH > 7.0.
CliniCal Diabetes • Volume 27, Number 1, 2009
Pitfalls
literacy skills.16,17 Careful discussion
Prevention
Volume 27, Number 1, 2009 • CliniCal Diabetes
diabetic subjects: the DIAD study. Diabetes
of diabetic ketoacidosis. J Clin Endocrinol RefeRences Endocrinol Metab Clin North Am 22:181–207,
Fulminant diabetes mellitus associated with
pregnancy: case reports and literature review.
litus: a disease of the kidneys that became
a kidney disease. J Nephrol 19 (Suppl.
betic ketoacidosis. Pediatr Crit Care Med
thyrotoxicosis and diabetic ketoacidosis
MB, Barrett EJ, Kreisberg RA, Malone JI,
resulted in sudden cardiac arrest. Endocr J
Wall BM: Hyperglycemic crises in patients
with diabetes mellitus. Diabetes Care 26
Chen WJ: Thyroid storm concealing diabetic
numeracy and diabetes control. Ann Intern
MB, Barrett EJ, Kreisberg RA, Malone JI,
Wall BM: Hyperglycemic crises in diabetes.
Diabetes Care 27 (Suppl. 1):S94–S102, 2004
Simultaneous presentation of type 1 diabetes
and thyrotoxicosis as a medical emergency. N
crises in urban blacks. Arch Intern Med
in adult patients with diabetes: a consen-
sus statement from the American Diabetes
Association. Diabetes Care 29:2739–2748,
A: Efficacy of subcutaneous insulin lispro
Michael Fowler, MD, is an assistant
versus continuous intravenous regular insulin
for the treatment of patients with diabetic
professor of medicine in the Division
MB, Barrett EJ, Kreisberg RA, Malone JI,
ketoacidosis. Am J Med 117:291–296, 2004
crises in patients with diabetes. Diabetes Care
Lambeth HC, Stentz F, Bush A, Kitabchi AE:
Thyroid dysfunction in patients with type 1
diabetes: a longitudinal study. Diabetes Care
Chyun DA, Davey JA, Barrett EJ, Taillefer
University Medical Center in Nashville,
R, Wittlin SD, Heller GV, Filipchuk N, Engel
Tenn. He is an associate editor of
S, Ratner RE, Iskandrian AE: Detection of
silent myocardial ischemia in asymptomatic
study of phosphate therapy in the treatment
CliniCal Diabetes • Volume 27, Number 1, 2009
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