Hyperglycemic

emergencies
1. HAMS MOHAMED 198384 B1
2. RIHAM MOHAMED 204270 B1
3. ZEINA MANSOUR 204722 B1
4. NOURHAN MAHMOUD 201774 B1
5. MARYAM AHMED 201460 A3
6. NOURAN HESHAM 200823 A3
7. REEM KHALED 204096 A3
8. SALMA HUSSIEN 201615 A3
9. MARIAM HAZIEM 201774 A3
10. Reem Yasser 195178 A3
11. Lama Hesham 199296 A3
 463
million people suffer from some type of diabetes
Table of contents
01 02
Definition and types Incidence rate

03 04
Causes Risk factor
Table of contents
05 06
Symptoms diagnosis

07 08
Management Complication
 Definition:
Hyperglycemic crisis is a metabolic emergency
associated with uncontrolled diabetes mellitus that
may result in significant morbidity or death. Acute
interventions are required to manage hypovolemia,
acidemia, hyperglycemia, electrolyte abnormalities,
and precipitating causes.
 Incidance rate :

Hyperglycemia (blood glucose > 140 mg/dL or

7.8 mmol/L) in hospitalized patients without a
history of diabetes is defined as stress
hyperglycemia and is reported in 32.2% of
critically ill patients in intensive care units and
30% of noncritically ill hospitalized patients.
 Types :
•Diabetic ketoacidosis (DKA), mainly in people with
type 1 diabetes.
•Hyperosmolar hyperglycemic state (HHS), mainly in
people with type 2 diabetes
Causes to consider
1. the basic cause of DKA and HHS is insufficient insulin effect.
2. the presence of infection
3. myocardial infarction, cerebrovascular accidents,
pulmonary embolism, pancreatitis.
4. alcohol and illicit drug use as Cocaine is associated with
recurrent DKA.
5. Drugs such as corticosteroids, thiazide diuretics,
sympathomimetic agents
Risk factor
•Obesity or being •Family history of type
overweight 2 diabetes or
gestational diabetes

•Presence of •Presence of
hyperlipidemia or polycystic ovarian
hypertension syndrome
 Symptoms
• Increased thirst
• Frequent urination
• Blurred vision
• Tiredness or weakness
• Headache
• Nausea and vomiting
• Shortness of breath
• Stomach pain
• Fruity breath odor
• A very dry mouth
 Diagnostic criteria
for DKA:

•Arterial pH ≤ 7.3.
•Serum bicarbonate ≤ 15mmol/L.
•Anion gap > 12mmol/L.
•Positive urine/serum ketones.
•Blood glucose <250 mg/dl.
 Diagnostic criteria
for HHS:

•Serum glucose <600 mg/dl.

•Serum osmolality < 320mOsm/kg.
•Minimal/no acidosis
Management:
1.fluid therapy:
First: Determine dehydration status:
1. Severe hypovolemia: give 0.9% NaCl 1L/hr
2. Mild to moderate: check serum Na+ if:

● High or normal serum Na+: give 0.45% NaCl (250-500 ml/hr)

depending on hydration state
● Low Na+: give 0.9% NaCl (250-500 ml/hr) depending on hydration
state.
•Once serum glucose reaches 200 mg/dl for DKA or 300 mg/dl for HHS
change to 5% dextrose with 0.45% NaCl at 150-250 ml/hr
Management:
2. insulin:
1. Regular insulin 0.1 U/kg IV bolus
2. Then 0.1 U/Kg/hr IV infusion
3. Increase insulin infusion rate by 50-100%, If glucose does
not fall by 10% (50 mg/dL) per hour

•DKA: Serum glucose reaches 200 mg/dl, reduce regular

insulin infusion to 0.05 U/Kg/hr IV.
•HSS: Serum glucose reaches 250 mg/dl, reduce regular
insulin infusion to 0.05 U/Kg/hr IV.

● Transition to SC insulin when patient is alert and able to

eat ,Overlap between IV and basal insulin should be at
least 2 hours
Management:
3. potassuim:
● K+ < 3.3 mmol/L, hold insulin and give 20-30
mmol/k+/hr until K+ > 3.3 mmol/L

● K+ =3.3-5.3 mmol/L, give 20-30 mmol K+ in

each liter of IV fluid to keep K+ between 4-5
mmol/L

● K+ > 5.3 mmol/L, do not give K+ but check K+

every 2 hrs
Complication:
● Cerebral edema
● Pulmonary edema
● Hypokalemia
● Hypocalcemia (if phosphate used)
● Seizures
● Stroke
● Acute renal failure
● Deep vein thrombosis
Resources
● https://pubmed.ncbi.nlm.nih.gov/23786780/#:~:text=Background%3A%20Hyperglycemic%20
crisis%20is%20a,electrolyte%20abnormalities%2C%20and%20precipitating%20causes.
● https://www.diabete.qc.ca/en/diabetes/information-on-diabetes/diabetic-
emergencies/hyperglycemic-emergencies/
● Fayfman, M., Pasquel, F. J., & Umpierrez, G. E. (2017). Management of Hyperglycemic
Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. The Medical clinics of
North America, 101(3), 587–606. https://doi.org/10.1016/j.mcna.2016.12.011
● Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., & Fisher, J. N. (2009). Hyperglycemic crises in
adult patients with diabetes. Diabetes care, 32(7), 1335–1343. https://doi.org/10.2337/dc09-
9032
● https://www.ncbi.nlm.nih.gov/books/NBK430900/
● https://www.mayoclinic.org/diseases-conditions/diabetic-coma/symptoms-causes/syc-
20371475