NYMC Faculty Publications

Hyperosmolar Diabetic Ketoacidosis-- Review of Literature and the Shifting Paradigm in Evaluation and Management

Author Type(s)

Faculty

DOI

10.1016/j.dsx.2021.102313

Journal Title

Diabetes & Metabolic Syndrome

First Page

102313

Last Page

102313

Document Type

Review Article

Publication Date

11-2021

Department

Pediatrics

Keywords

Adolescent, Child, Diabetic Ketoacidosis, Disease Management, Female, Fluid Therapy, Humans, Hyperglycemic Hyperosmolar Nonketotic Coma, Hypoglycemic Agents, Insulin, Male, Randomized Controlled Trials as Topic

Disciplines

Medicine and Health Sciences

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.

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