Perbandngan tindakn hyoerglicemia krisis dalam terapi

1. DKA & HHS
Hyperglycemia Crisis Management
Dieni Azra

2. • DKA & HHS associated with high mortality rates if left not treated.
• significant likelihood of morbidity & mortality, including cerebral edema,
permanent neurological injury & death.
• mortality rate for DKA is < 1% & ~ 15% for HHS.
• DKA & HHS have similar pathophysiology with some few differences.
• occur because of lack of insulin effect
• Typically, pts with T1DM more likely to exhibit DKA because of absolute
insulin deficiency, & T2DM more likely to experience HHS

3. Pathophysiology basic cause: insufficient insulin effect

4. Precipitating cause

5. Diagnosis – History & Physical exam
DKA
• develops rapidly, over a
time span of <24 h
• nausea & vomiting:
common symptom
• Abdominal pain,
sometimes mimicking an
acute abdomen
• full alertness to profound
lethargy
• fruity breath odor,
• Kussmaul
HHS
• several days before
admission
• polyuria, polydipsia &
weight loss
• mental obtundatioh & coma
 more frequent

6. Laboratory
• Immediate: BG, ABG, & Ureum/BUN
• serum electrolytes,osmolality, creatinine & ketones
• urinalysis; ketonuria
• CBC with differential.
• Bacterial cultures of urine, blood, & other tissues 
appropriate antibiotics should be administered if
infection is suspected.

7. Diagnosis

8. Diagnosis

10. Treatment
• Cornerstones: fluids, insulin, correction of electrolyte
abnormalities & close monitoring
• therapeutic goals:
1) improving circulatory volume and tissue perfusion
2) decreasing serum glucose & plasma osmolality to normal
levels
3) clearing serum & urine of ketones at a steady rate
4) correcting electrolyte imbalances
5) identifying & treating precipitating events

11. Deficit
DKA
• Total water: 5-7 l
(100ml/kg)
• Sodium: 7-10 mmol/kg
HHS
• 7-9 l
(100-200ml/kg)
• Sodium: 5-13mmol/kg

12. Fluid rescucitation
• improving circulatory volume & tissue perfusion
• decreasing serum glucose & plasma osmolality to
normal levels
• correcting electrolyte imbalances
• Dilution: reduce BG & contra insulin hormone
concentration
• Fluids: NS
Sodium >/= 140 mEq/L: NaCl 0.45%

15. Date of Download: 7/25/2023 Copyright © 2023 American Diabetes Association. All rights reserved.
Protocol for management of DKA or HHS
Diabetes Care. 2009;32(7):1335-1343. doi:10.2337/dc09-9032
serum Na should be corrected for hyperglycemia (for each 100 mg/dl glucose 100 mg/dl, add 1.6 mEq to sodium value for corrected serum
value

18. Monitoring
• serum glucose: every 1-2 h during treatment
• Serum electrolytes: every 2-6 h, depending on the clinical
response of the patient
• the precipitating factor must be identified & treated.

19. Resolution

20. Date of Download: 7/25/2023 Copyright © 2023 American Diabetes Association. All rights reserved.
From: Management of Hyperglycemic Crises in Patients With Diabetes
Diabetes Care. 2001;24(1):131-153. doi:10.2337/diacare.24.1.131

21. Thank you