Diabetic ketoacidosis (DKA).
It is a serious state resulting from a relative or absolute deficiency of insulin. DKA is prevalent in type 1 diabetic patients.. It is characterized by a triad of symptoms consisting of hyperglycemia with serum glucose above 250mg/dL, pH levels less than 7.3, bicarbonate levels less than 15mmol/L and moderate or large ketone levels in serum or urine (Rewers, 2018). Diabetic patients who present with Kussmaul’s breathing with a fruity smell, dehydration, abdominal pains, and altered mental status are likely to have DKA. The treatment principles are administering fluid replacement therapy correct dehydration, electrolyte imbalance, and acidosis (Rewers, 2018). In addition, hyperglycemia is managed by the administration of insulin.
Hyperglycemic Hyperosmolar State (HHS).
It is the severe increase of serum glucose of more than 600mg/dL and blood osmolality of more than 320 mOsm/kg without acidosis and ketosis (Rewers, 2018). Ketones can be found in low amounts, either in blood or urine. HHS is prevalent in older patients above 65 years with type 2 diabetes. The risk factors of HHS include infection, myocardial infarction, stroke, and alcohol abuse (Rewers, 2018). Patients with type 2 DM should be educated on the importance of constant monitoring of serum glucose, medication adherence, and appropriate diet to prevent the occurrence of HHS.
This is characterized by increased lactic acid above 5.0 mEq/L, acidosis, and the absence of ketoacidosis. Conditions that impair oxygenation, such as sepsis, hypoxemia, carbon monoxide poisoning, and shock, are the precipitating factors of lactic acidosis (Rewers, 2018). The goal is to inhibit lactic acid production by ensuring adequate tissue oxygenation. Treatment of Underlying conditions that cause hypoxic events such as cardiovascular disorders, correction of hyperglycemia, and restoring fluid volume is significant in preventing LA.
Rewers, A. (2018). Acute Metabolic Complications in Diabetes (C. C. Cowie, S. S. Casagrande, A. Menke, M. A. Cissell, M. S. Eberhardt, J. B. Meigs, E. W. Gregg, W. C. Knowler, E. Barrett-Connor, D. J. Becker, F. L. Brancati, E. J. Boyko, W. H. Herman, B. V. Howard, K. M. V. Narayan, M. Rewers, & J. E. Fradkin, Eds.). PubMed; National Institute of Diabetes and Digestive and Kidney Diseases (US). https://www.ncbi.nlm.nih.gov/books/NBK567993/#:~:text=Diabetic%20ketoacidosis%20(DKA)%2C%20hyperglycemic
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