NYMC Faculty Publications
Hyperosmolar Diabetic Ketoacidosis-- Review of Literature and the Shifting Paradigm in Evaluation and Management
Author Type(s)
Faculty
Journal Title
Diabetes & Metabolic Syndrome
First Page
102313
Last Page
102313
Document Type
Review Article
Publication Date
11-2021
Department
Pediatrics
Abstract
BACKGROUND: Hyperosmolar diabetic ketoacidosis (H-DKA), a distinct clinical entity, is the overlap of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS).
AIM: We describe the clinical presentation, metabolic aberrations, and associated morbidity/mortality of these cases with H-DKA. We highlight the problem areas of medical care which require particular attention when caring for pediatric diabetes patients presenting with H-DKA.
METHODS: In our study we reviewed the literature back to 1963 and retrieved twenty-four cases meeting the criteria of H-DKA: glucose >600 mg/dL, pH < 7.3, bicarbonate320 mOsm/kg, while adding three cases from our institution.
RESULTS: Average age of presentation of H-DKA was 10.2 years ± 4.5 years in females and 13.3 years ± 4 years in males, HbA1c was 13%. Biochemical parameters were consistent with severe dehydration: serum osmolality = 394.8±55 mOsm/kg, BUN = 48±22 mg/dL, creatinine = 2.81±1.03 mg/dL. Acute kidney injury, present in 12 cases, was the most frequent end-organ complication.
CONCLUSION: Multi-organ involvement with AKI, rhabdomyolysis, pancreatitis, neurological and cardiac issues such as arrhythmias, are common in H-DKA. Aggressive fluid management, insulin therapy and supportive care can prevent acute and long term adverse outcomes in children and adolescents.
Recommended Citation
Brar, P., Tell, S., Mehta, S., & Franklin, B. (2021). Hyperosmolar Diabetic Ketoacidosis-- Review of Literature and the Shifting Paradigm in Evaluation and Management. Diabetes & Metabolic Syndrome, 15 (6), 102313-102313. https://doi.org/10.1016/j.dsx.2021.102313
