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“…It accounts for 8% to 28% of all primary diabetic admissions to a hospital (1). The mortality rate has decreased from 10% in the 1980s to 0.21% to 2% in a recent series (2,3).…”
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“…It accounts for 8% to 28% of all primary diabetic admissions to a hospital (1). The mortality rate has decreased from 10% in the 1980s to 0.21% to 2% in a recent series (2,3).…”
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“…The guideline states the classification of hyperglycemic crises and gives advice on monitoring the patient, fluid and electrolyte management, and the use of intravenous dextrose, but it is not a completely automated algorithm; rather, clinical judgment is required. The consideration of withholding insulin despite severe hyperglycemia should apply in patients with arterial hypotension, and in patients with significant hypokalemia; these conditions emergently require volume expansion and initiation of potassium replacement respectively, before starting insulin [31]. Limitations of applicability of the algorithm are stated in the physician guideline.…”
Section: Rationale For Insulin Rules Of the Protocolmentioning
“…More likely, the lack of ketosis is related to the lower levels of counterregulatory hormones (e.g., glucagon and catecholamines) seen in HHS. 27 As with DKA, an insulin deficiency coupled with an altered counterregulatory hormone profile leads to increased gluconeogenesis and impaired glucose utilization. As large amounts of glucose saturate the urine, the concentrating capacity of the kidney is impaired, and significant free water diuresis occurs.…”
Section: Pathophysiologymentioning