A pragmatic overview of Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycaemic Syndrome (HSS).
If diabetes is undiagnosed or uncontrolled, a series of metabolic events can occur that lead to diabetic ketoacidosis (DKA). DKA is a combination of hyperglycaemia, ketonaemia and metabolic acidosis. Not all patients with diabetic ketosis will be acidotic.
DKA is relatively uncommon, but potentially life-threatening and can occur in unstable diabetic patients and, on occasion, in stable diabetic patients that have precipitating factors that have caused this, such as infection/inflammation, metabolic disease, endocrine disease, cardiorespiratory disease or drugs administered for other issues.
Hyperglycaemia Hyperosmolar Syndrome (HHS) occurs when there is slightly more insulin present than in cases of DKA, so there is enough insulin to suppress ketogenesis, but not enough to control hyperglycaemia.
No two cases are ever the same with some patients appearing quite well on presentation whilst others are collapsing. No protocol is significantly superior in the treatment of either DKA or HSS. Prognosis for DKA is likely reasonable, HSS is far less common but prognosis is significantly poorer.
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