Hyperosmolarity and acidosis in diabetes mellitus

Abstract

1) many patients experience mixed DA (DKA) and DHS rather than either condition alone, 2) both DA (DKA) and DHS occur in young and old diabetic persons, 3) infection is the most common predisposing factor for either condition, and 4) higher osmolarity, older age, and nursing home residence are associated with nonsurvival in DHS.

Hyperglycaemic crisis in the Eastern Cape province of South Africa: High mortality and association of hyperosmolar ketoacidosis with a new diagnosis of diabetes

“…100, No. 12 SAMJ NHDKA agrees with other reports, 6,7,11,13 the former had a similar mortality rate to HHS despite the patients being more than 20 years younger. This underscores the need to distinguish between these forms of ketoacidosis, as the combination of hyperosmolality and ketoacidosis had a worse prognosis than ketoacidosis alone despite both ketoacidotic groups being relatively young.…”

“…The overall mortality rate of 20.2% (deaths per all admissions) in the study, with a range from 13.4% for NHDKA to 37.5% for HDKA, is higher than the rates of 2.7 -7.7% for NHDKA and 0 -9.6% for HDKA from centres 6,7,11 that admit patients with hyperglycaemic crisis into high-care units. Patients with hyperglycaemic emergencies in Jamaica, 13 also managed in the medical wards, had lower mortality rates than ours (6.7%, 25% and 20.3% for NHDKA, HDKA and HHS, respectively), indicating that additional factors contribute to our high mortality rates.…”

“…[2][3][4][5][6][7][8][9] It is characteristically classified as ketoacidotic or hyperosmolar. 10 Presentations with the combination of ketoacidosis and hyperosmolality are recognised, 6,7,[11][12][13][14][15][16] and have variably been described as ketoacidosis with hyperosmolality or hyperosmolar state with ketoacidosis, depending on whether ketoacidosis or hyperosmolality was considered dominant. 15 Therapy and outcome of treatment for hyperglycaemic crisis is related to the presence of hyperosmolality and ketoacidosis.…”

“…1 Hyperosmolality is associated with the use of hypotonic fluids, anticoagulation and the more frequent occurrence of vascular thrombosis, 17 while ketoacidosis may necessitate the use of sodium bicarbonate. 18 Hyperglycaemic hyperosmolar non-ketoacidosis is associated with a higher morbidity and mortality than diabetic ketoacidosis, 6,7,19 which is mainly attributed to hyperosmolality, older age 6,7 and the more frequent association of hyperosmolar non-ketoacidosis with type 2 diabetes. 19 Few studies 6,7,11,13 have described the clinical and laboratory features and outcomes of treatment for hyperosmolar diabetic ketoacidosis.…”

Comparing Biochemical Profile of Admitted Patients with the Various Groups of Hyperglycemic Emergencies

“…The decreased ratio of insulin to glucagon promotes gluconeogenesis, glycogenolysis and ketone body formation in the liver as well as increase in substrate delivery from fat and muscle (free fatty acids, amino acids) to the liver 1 . The initial laboratory evaluation includes determination of plasma glucose, blood urea nitrogen, creatinine, serum ketones, electrolytes (with calculated anion gap), osmolality, urinalysis, urine ketones by dipstick, as well as initial arterial blood gases and complete blood count with differentials 6 . An electrocardiogram, chest x-ray and urine, sputum or blood cultures should also be obtained, if clinically indicated 6 .…”