Acute hyperglycemic syndromes: Diabetic ketoacidosis and the hyperosmolar state

Abstract

The patient, often a "repeat offender" who stops taking insulin, presents with increasing urination and thirst along with nausea, vomiting, abdominal pain, dehydration, weakness, and dizziness. The patient may become confused and slip into coma. The respiratory compensation that accompanies acidemia causes deep rapid (Kussmaul) breathing. The sweet smell of the volatile ketone body acetone signals the possibility of ketoacidosis. The treating physician seeks to reestablish normal physiology and restore the patient to normal function. Thankfully, treatment is remarkably straightforward and involves intravenous fluid, insulin, potassium, and vigilance.