Ketoacidosis and the hyperosmolar hyperglycemic state in adult diabetic patients. Diagnosis and treatment.

Diabetic ketoacidosis (DKA) and the hyperosmolar hyperglycemic state (HHS) are serious acute decompensations of type 1 and 2 diabetes mellitus due to various degrees of insulin deficiency and increased levels of counterregulatory hormones. They are characterized by hyperglycemia and hyperosmolarity in HHS, and by hyperglycemia and ketoacidosis in DKA with major electrolyte imbalance; both can co-exist. Precipitating factors can usually be identified. The diagnosis can usually be suspected on clinical grounds, but must be confirmed by laboratory investigation. Treatment consists of appropriate rehydration, intravenous insulin therapy and potassium supplementation. Careful monitoring of the patient's clinical and biochemical status throughout treatment is critical. Excess mortality still occurs, particularly for HHS, emphasizing the importance of patient education and regular follow-up to prevent these potentially fatal complications.