Diagnosis and stepwise management of diabetic ketoacidosis, hyperosmolar hyperglycemic state, hypoglycemia, thyroid storm and myxedema coma, and adrenal crisis.
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- What blood glucose level is part of the diagnostic criteria for diabetic ketoacidosis (DKA)?
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Greater than 250 mg/dL (can be lower in euglycemic DKA)- What arterial pH helps define DKA?
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Less than 7.3- What serum bicarbonate level supports a diagnosis of DKA?
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Less than 18 mEq/L- What is the formula for the anion gap?
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Na minus (Cl plus HCO3)- What is the first step in managing DKA, before starting an insulin infusion?
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IV fluid resuscitation with isotonic saline- Before starting an insulin infusion in DKA, what minimum serum potassium should be confirmed?
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About 3.3 to 3.5 mEq/L- At what blood glucose level should dextrose be added to IV fluids during DKA treatment?
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Around 200 to 250 mg/dL- What three findings together indicate DKA has resolved?
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Glucose under 200 mg/dL, bicarbonate 15 or greater, and a closed (normal) anion gap- What blood glucose level is typical for diagnosing hyperosmolar hyperglycemic state (HHS)?
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Greater than 600 mg/dL- What serum osmolality is characteristic of HHS?
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Greater than 320 mOsm/kg- Unlike DKA, what are the typical ketone and pH findings in HHS?
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Absent or minimal ketosis with a near-normal pH, usually above 7.3- About how large is the free water deficit in a typical HHS presentation?
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Around 8 to 10 liters- What is the cornerstone of HHS management?
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Aggressive IV fluid resuscitation, started before or alongside a lower-dose insulin infusion- How does the mortality rate of HHS compare to DKA?
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HHS has a higher mortality rate than DKA- What are the three components of Whipple's triad?
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Low blood glucose, symptoms consistent with hypoglycemia, and relief of symptoms once glucose is raised
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