Cekoaedosis y Estado Wiper lo éenita H iprrosma fa Cetercicloss : - Hipergliemia Cé AMP de DA2) - Actdoscs mefabslica fad Cefonemig S Eslodo Liperslvetmne H lar (HHS): - Hiperal Sever ie -4 Pe lara Seddon ~ Dahideoboasn “HSS es minas Comin, Representa < 17+ de (a5 admesiones — fs loge enanlrs Cases: defreencr, asalla o tlodiva inslina + Aemuo de lormonas Contmrmpgpaloros, Table 1 | Diagnostic criteria for diabetic ketoacidosis in adults Criteria ADA’ uk’ ‘AACE/ACE* Year of publication 2009 2013 2016 Plasma glucose concentration, >13.9 (250mg/dL)" >11 6200 mg/dL)or NA mmol/L known diabetes pH Mild: 7.25-7.30; moderate: «7.3 (evere:<7.0) ae 24; severe: © Bicarbonate concentration, ‘Mild: 15-18; moderate «15 (severe:<5) NA mmol/L or mEq/L 10-149; severe:<10 Anion gap: Na‘—(CI-+HCO,") Mild: »10; moderate: »12; NA (evere:>16) 10 severes12 Urine acetoacetate Positive Positive Positive (nitroprusside reaction) Blood B-hydroxybutyrate, NA’ 23 (31 mg/dl) Gevere:»6) 23.8 (40 mg/dl) mmol/L Mental status ila moderate: alertor NA Drowsy, stupor, or lrowsy; severe: stupor or coma comaaT \eRIe bony fica rar meee ey there rar oe cr eerie temeertine: ae eeeeteeeerr eer ieee reeeire terete raeee errr tae reat ee ie teeeaiareeeeeeaeee eee eee arse Association; NA=not included in guideline document. *2019 ADA guideline provides update to this 2009 guideline and now states “There is considerable variability..canging from. euglycemia or mild hyperglycemia and acidosis to severe hyperglycemia, dehydration, and coma,"* +B-hydroxybutyrate updated to 3 mmol/L in 2016 updated review cited in 2019 ADA guideline*” oer Credecras fara Ce oacidess ds ADA a MACE 4) ; #3S-2.25 J 25-4. ¥ AACE tmtlar per Pasi te Mae ede HCO, Y am Uslor ce Celoras HCO: If- Is he 1s— {0 C) <10 (eda 5) GAP {0 / + Gakeint 1 3167 ) Codanas Ea ofing J ie el Table 2| Diagnostic criteria for hyperglycemic hyperosmolar state in adults Criteria ADA uk Year of publication 2009 2015 Plasma glucose concentration, mmol/L 7333, 30 >» 540-595 give. 7.30 730 >2-30 eH mmol/L 18" 15 >19 braSOP: NS TE SIN badd acetoacetate (nitroprusside reaction) Negative orlow p NA Blood B-hydroxybutyrate, mmol/L NA 3 Osmolality, mmol/kg 320° 2320" Osa> Presentation Stupor or coma Severe dehydration and feeling unwell "ADA=American Diabetes Association; NA=notincluded in guideline document. &_, *Updated to>15 mmol/L in 2016 updated review cited in 2019 ADA guideline 7 Arrerto\ + Rshidratosson ADA guideline calculates effective plasma osmolality using equation 2xNa+glucose (mmol/L) or 2xNa+glucose (mg/ dt)/18. 4UK guideline calculates osmolality using equation 2xNa+glucose (mmol/L) +(blood urea nitrogen (mmol/L) or 2xNaeglucose (mg/dl)/18+blood urea nitrogen (mg/dl))/2.8. 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