What is the difference between DKA and HHNK?
DKA typically evolves within a few hours, whereas HHNS is much slower and occurs over days to weeks, according to 2021 research . The two conditions look similar because of the hyperglycemia component of each condition. Knowing the symptoms of each can help you seek medical care as soon as possible.
How is euglycemic ketoacidosis diagnosed?
As described previously, the patient will have normoglycemia (capillary blood glucose less than 250 mg/dL) in the presence of metabolic acidosis (pH less than 7.3) and a total decreased serum bicarbonate (less than 18 mEq/L). Serum and urine ketones must be elevated to make the diagnosis of EDKA.
Why is HCO3 low in DKA?
Acid–base balance, fluids and electrolytes. Acidosis in DKA is due to the overproduction of β-hydroxybutyric acid and acetoacetic acid. At physiological pH, these 2 ketoacids dissociate completely, and the excess hydrogen ions bind the bicarbonate, resulting in decreased serum bicarbonate levels.
Why is BUN and creatinine high in DKA?
Diabetic ketoacidosis is usually accompanied by dehydration resulting in prerenal azotemia, in which the levels of blood urea nitrogen are elevated out of proportion to those of the serum creatinine (1).
What is Nonketotic hyperosmolar syndrome?
DEFINITION. Hyperosmolar coma (nonketotic hyperosmolar syndrome) is a state of extreme hyperglycemia, marked dehydration, serum hyperosmolarity, altered mental status, and absence of ketoacidosis.
What is the key differentiating factor between DKA and HHS?
The key difference between HHS and DKA is that DKA is characterized by the presence of ketones in the blood and acidosis, but HHS means these are completely absent. Even though DKA and HHS are similar, their management strategies have their own nuances.
Who gets euglycemic DKA?
Euglycemic DKA is an uncommon diagnosis but can occur in patients with type 1 or type 2 diabetes mellitus. With the addition of sodium/ glucose cotransporter-2 inhibitors in diabetes mellitus management, euglycemic DKA incidence has increased.
What medication causes euglycemic DKA?
DKA is characterized by hyperglycemia, acidosis, and ketonemia, and sodium glucose transporter 2 inhibitors (SGLT2i) represent a new diabetes medication that has been associated with euglycemic DKA (eu-DKA).
Do you give sodium bicarb in DKA?
Although no prospective randomized trials have been conducted on patients with severe DKA, the American Diabetes Association recommends the administration of 100 mmol sodium bicarbonate in 400 mL sterile water with 20 mEq of KCl to patients with a pH of less than 6.90 until the pH rises above 7.00[5].
When do you stop bicarb drip in DKA?
Most protocols require that the bicarbonate be >15 mEq/L before stopping the insulin drip. Therefore, persistent non-gap acidosis may delay transition off the insulin drip. Metabolic acidosis increases insulin resistance.
Why is potassium low in DKA?
DKA is a well-known cause of hypokalemia caused by osmotic diuresis leading to a total body potassium deficiency of 3 to 6 mEq/kg. At presentation, potassium levels are typically “normal” due to the extracellular shift of potassium (K+) from insulin deficiency and acidosis.
What is a good ketone level?
Blood ketone levels while on the keto diet typically range from 0.5 – 3.0 millimoles per liter (mmol/L) ( 1 ). These levels are the optimal range for nutritional ketosis — the state in which your body can use stored fat for energy most effectively, helping boost weight and fat loss ( 1 ).
What does Nonketotic mean?
Nonketotic hyperglycinemia is a disorder characterized by abnormally high levels of a molecule called glycine in the body (hyperglycinemia). The excess glycine builds up in tissues and organs, particularly the brain.
What’s the difference between HHS and DKA?
DKA is characterized by ketoacidosis and hyperglycemia, while HHS usually has more severe hyperglycemia but no ketoacidosis (table 1). Each represents an extreme in the spectrum of hyperglycemia. The precipitating factors, clinical features, evaluation, and diagnosis of DKA and HHS in adults will be reviewed here.