DKA and HHS recommendations made after review
Researchers have published a series of recommendations for the acute management of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome following a review of evidence.
The guidance developed by a team from University of Pittsburgh has been published by the BMJ.
As well as the recommendations for acute management of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS), it covers the complications associated with the disorders and methods for preventing recurrence.
It also discusses why many people who present with these disorders are at high risk for hospital readmissions, early morbidity, and mortality well beyond the acute presentation.
Summarising the guidance, the researchers said: “Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS) are life-threatening complications that occur in patients with diabetes. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids with appropriate replacement of electrolytes (primarily potassium).
“In patients with diabetic ketoacidosis, this is always followed by administration of insulin, usually via an intravenous insulin infusion that is continued until resolution of ketonemia, but potentially via the subcutaneous route in mild cases. Careful monitoring by experienced physicians is needed during treatment for diabetic ketoacidosis and HHS. Common pitfalls in management include premature termination of intravenous insulin therapy and insufficient timing or dosing of subcutaneous insulin before discontinuation of intravenous insulin.”
To access ‘Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients’, click here.
Picture credit: Marcelo Leal