Diagnostic approach and initial management of ketoacidosis and hyperglycemic hyperosmolar state in adults: Narrative review

Abstract

Introduction: Diabetes mellitus is a highly prevalent metabolic disease caused by deficiency and/or resistance to insulin that elevates blood glucose. Two of its acute complications are ketoacidosis and hyperosmolar hyperglycemic state, which can potentially be fatal. Objective: To describe the diagnosis and initial management of diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults. Methodology: Narrative literature review that included information from scientific databases, books, and journal articles focused on adults in English and Spanish published in the last 5 years. Results: A total of 64 documents were collected from which 30 bibliographies that met the selection criteria were included. Discussion: Ketoacidosis is characterized by the production of ketones, due to insufficient insulin and increased glucose, leading to metabolic acidosis. On the other hand, the hyperosmolar hyperglycemic state produces changes in osmolarity and osmotic diuresis. The clinical picture of ketoacidosis usually begins with polydipsia, polyuria and polyphagia, while the hyperosmolar hyperglycemic state manifests itself with polyuria, polydipsia and dehydration. Effective treatment for both is based on 3 axes; hydration followed by individualized insulin therapy and finally electrolyte compensation. Conclusions: Timely diagnosis based on clinical history and laboratory tests allow establishing the appropriate treatment based on proper hydration, insulin administration, and electrolyte replacement.