Run the List Acute Hyperglycemic Episodes
Jul 10, 2020
Dr. Nadine Palermo, an endocrinologist and Associate Director of Acute Diabetes Care at Brigham and Women's Hospital, dives deep into acute hyperglycemic episodes. She elucidates the pathophysiology and risks of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), stressing the importance of a comprehensive diagnosis which goes beyond textbook signs. Treatment strategies including fluid management and insulin timing are discussed, alongside clinical pearls that reveal DKA's presence in varied diabetes cases.
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Case: Pneumonia Triggering Hyperglycemia
- A 63-year-old man with insulin-dependent diabetes presented with thirst, nausea, vomiting, fever, and confusion.
- ED findings included glucose ≈400, dehydration, and a chest x-ray consistent with pneumonia.
Shared Pathophysiology Of Hyperglycemic Crises
- Insulin deficiency drives both DKA and HHS via hyperglycemia and osmotic diuresis.
- Volume depletion then raises counter-regulatory hormones that worsen hyperglycemia.
Use Simple Criteria To Differentiate DKA vs HHS
- Diagnose DKA with glucose >250, ketones, and acidemia (pH <7 or low bicarb).
- Calculate HHS by high glucose often >600 and effective osmolarity >320 using measured sodium.