In today's Rapid Fire Morning Report, we discussed the management of DKA.
To review, diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state (HHS), formerly known as hyperosmolar non-ketotic coma (HONK) are caused by the combination of:
1) absolute (in DKA) or relative (in HHS) insulin deficiency AND 2) upregulation of counter-regulatory hormones, such as glucagon, cortisol, and growth hormone. This results in increased glycogenolysis and hepatic gluconeogenesis.
The hyperglycemic state leads to osmotic diuresis and intravascular volume depletion. In DKA, the breakdown of triglycerides results in the release of free fatty acids leading to ketogenesis.
Important things to remember:
- It is always important to elucidate the precipitant in order to treat it and prevent further events from occurring.
- The pillars of treatment include intravascular fluid resuscitation (primarily treating the hyperglycemia), intravenous insulin therapy (primarily treating the ketoacidosis), and total body potassium repletion.
- The role of bicarbonate and phosphate are controversial.
Please click on the link below for access to an excellent review article on the Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state by Chiasson et al. from CMAJ (2003):
http://www.ecmaj.ca/content/168/7/859.full.pdf
