Tags
Emerg. Med. Practice
Published
February 1, 2020
Author(s)
H. Evan Dingle, MD;
Corey Slovis, MD, FACP, FACEP, FAAEM, FAEMS
Action
Patient presents with suspected DKA/HHS:
- Check glucose
- Check VBG
- Send urinalysis; check for ketones
- Perform ECG
Decision
DKA criteria or HHS criteria met?
Background
DKA (mild, moderate, severe) vs HHS
Test | DKA, mild | DKA, moderate | DKA, severe | HHS |
pH | 7.25 - 7.30 | 7.00 - 7.24 | <7 | Normal (or mild decrease) |
Serum Glucose | Typically
>250 mg/dL
(13.9 mmol/L) | Typically
>250 mg/dL
(13.9 mmol/L) | Typically
>250 mg/dL
(13.9 mmol/L) | >200 mg/dL
(11.1 mmol/L) |
Serum Bicarb (mEq/L) | 15-18 | 10 to <15 | <10 | >18 |
Urine Ketones | Positive | Positive | Positive | Trace or none |
Serum Ketones (Beta-hydroxybutyrate)
| Positive | Positive | Positive | Small |
Serum Osm.(mOsm/kg) | Variable | Variable | Variable | >320 |
Anion Gap | >10 | >12 | >12 | Usually normal |
Mental Status | Alert | Alert, Drowsy | Stupor, Coma | Stupor, Coma |
Sources:
- Dingle HE, Slovis C. Diabetic hyperglycemic emergencies: a systematic approach. Emerg Med Pract. 2020 Feb;22(2):1-20. Epub 2020 Feb 1. PMID: 31978294.
- Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32(7):1335-1343.
- Ashoo, S. EB Medicine FOAMed online publication: DKA vs HHS, https://foamed.ebmedicine.net/rapid-reference/dka-vs-hhs/
Table 4. Initial Diagnostic Workup for Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State
Recommended for all Patients
- Chemistry panel
- Venous blood gas
- Serum osmolality
- Urinalysis
- Complete blood cell count
- Bedside glucose
Situation-Dependent
- 12-lead electrocardiogram
- Lipase
- Blood and urine cultures
- Serum beta hydroxybutyrate (if available)
- Troponin
- Lactic acid
- Pregnancy test
- Urine drug screen
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Full DKA vs HHS Pathway
Criteria Met
Criteria Not Met