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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