Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Explore these free sample topics:
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- Results from a relative insulin deficiency in the undiagnosed or untreated diabetic
- Sustained hyperglycemia creates an osmotic diuresis and dehydration:
- Extracellular space maintained by the osmotic gradient at the expense of the intracellular space
- Eventually profound intracellular dehydration occurs.
- Total body deficits of H2O, Na+, Cl−, K−, PO4−, Ca2+, and Mg2+
- In contrast to diabetic ketoacidosis (DKA), severe ketoacidosis does not occur:
- Circulating insulin levels are higher.
- The elevation of insulin counter-regulatory hormones is less marked.
- The hyperosmolar state itself inhibits lipolysis (the release of free fatty acids) and subsequent generation of keto acids
- Most commonly seen in elderly type II diabetics who experience a stressful illness that precipitates worsening hyperglycemia and reduced renal function
- In the elderly, 30–40% of cases are associated with the initial presentation of diabetes.
Hyperosmolar hyperglycemic states (HHS) rare in pediatric patients
- Hyperosmolar state precipitated by factors that:
- Impair peripheral insulin action
- Increase endogenous or exogenous glucose
- Decrease patient's ability to replace fluid loss
- Infection is the most common precipitating factor in 32–60% of cases.
- Other precipitating causes include:
- Inadequate diabetes therapy
- Medication omission
- Diet indiscretion
- Calcium channel blockers
- Myocardial infarction
- Renal failure
- Heat stroke
- Intestinal obstruction
- Endocrine disorders
- Heat stroke