Diabetes - Stanford University



Key points for management of DKA and hyperosmolar hyperglycemic states (HHS or non-ketotic hyperglycemia)

• Refer to flow charts on following page.

• Check for precipitants. Most common precipitant of DKA or hyperglycemic hyperosmolar states (HHS) is infection. Other precipitants include myocardial infarction, stroke, alcohol abuse, pancreatitis, trauma. (Note that amylase and lipase are often elevated in DKA in patients without evidence of pancreatitis.)

• Mainstays of therapy are fluids, insulin, potassium, and assessing need for bicarbonate (in DKA). Refer to figure for details.

• Average fluid deficit in DKA is 6 L; in HHS is 9 L.

• Intravenous insulin treatment of choice for DKA in moderate to severe cases (i.e. bicarbonate 12).

• Insulin bolus is 0.15 U/kg iv followed by 0.1 U/kg/hr (generally 5-7 units/h) in adults (once hypokalemia K 18-19 µg/dL rules out adrenal insufficiency (caution in setting of OCP use).

• Random level 0.5 g/day or cellular casts)

Neurologic disorder (seizures or psychosis)

Hematologic disorder (hemolytic anemia or leukopenia ................
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