This document discusses the diagnosis and treatment of hyperglycemic crises in adult patients with diabetes mellitus. It addresses diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), defining their diagnostic criteria and typical clinical presentations. For DKA, symptoms develop rapidly and include abdominal pain and Kussmaul breathing. For HHS, symptoms develop more gradually over days and include neurological changes with dehydration. Laboratory findings for both conditions include high blood glucose, electrolyte abnormalities, and metabolic acidosis. Treatment involves fluid resuscitation, insulin administration, electrolyte replacement, and identifying and treating any precipitating factors.

1. Crisis de hiperglicemia en pacientes adultos con Diabetes Mellitus MARIA ALEJANDRA ENRIQUEZ R I MEDICINA INTERNA FUSM

2. Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate. Crisis de hiperglicemia en DM

3. CRITERIOS DIAGNOSTICOS PARA CAD Y HHS Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.

4. Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate. Crisis de Hiperglicemia en DMEpidemiologia

5. Patogenesis Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.

6. Patogenesis Kitabchi, Abbas E; Epidemiology and pathogenesis of diabetic ketoacidosis and Hyperosmolar hiperglycemic state, Agosto 2009

7. Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.

8. Factoresprecipitantes Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.

9. Factores precipitantes Data from: Kitabchi, AE, Umpierrez, GE, Murphy, MB, et al. Management of hyperglycemic crises in patients with diabetes mellitus (Technical Review). Diabetes Care 2001; 24:131

10. Factores precipitantes Data from: Kitabchi, AE, Umpierrez, GE, Murphy, MB, et al. Management of hyperglycemic crises in patients with diabetes mellitus (Technical Review). Diabetes Care 2001; 24:131

11. CAD desarrollo rápido, 24-horas, dolor abdominal y respiración Kussmaul HHS insidiosa, con poliuria, polidipsia y pérdida de peso, varios días antes de su ingreso. Sintomas neurológicos progresivos incluyendo letargo, signos focales, y obnubilación, progresar a coma en etapas posteriores Presentación Clínica Kitabchi Abbas, Clinical Features and Diagnosis of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults Enero 2010, Uptodate

12. Osmolaridad elevada causa alt. Neurológicas. >320 mmol/kg Osmolaridad efectiva= 2Na + glucemia/18 urea no induce cambios intracelulares en volumen o el gradiente osmótico de la membrana celular Diuresis osmótica, perdida de agua Na Y K. Osmolaridad normal, y sx neurológicos obliga a buscar otras causas Presentación clínica Kitabchi Abbas, treatment of diagnosis of Diabetic Ketoacidosis and Hyperosmolar Hyperglicemic state in adults Enero 2010, Uptodate

13. Dolor abdominal, En CAD 40%, en relación con severidad de acidosis Se relaciona con HCO3 5-15 Lento vaciamiento gástrico Desequilibrio H – Electrolítico Si persiste post a resolución de CAD buscar otras causas. Presentación clínica Kitabchi Abbas, Clinical Features And diagnosis of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic state in adults, Jan 2010, Uptodate.

14. Hallazgos de Laboratorio Diabetes Care, American Diabetes Association, July 2009

15. Hallazgos de laboratorio Kitabchi Abbas, Clinical features and diagnosis of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.

16. Hallazgos de laboratorio Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.

17. La gravedad de acidosis metabólica depende La tasa de producción de cetoacidos. La duración de la producción cetoácido Tasa de excreción urinaria. ( depende funcion renal) El anión gap: Estimación de la cantidad de aniones no medidos en suero anion gap = Na sérico - (Cl + HCO3) Hallazgos de Laboratorio Kitabchi Abbas, Clinical Features and diagnosis of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Jan 2009, Uptodate.

18. Hallazgos de Laboratorio Kitabchi Abbas, Features and diagnosis of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Jan 2009, Uptodate.

19. Hallazgos de Laboratorio Kitabchi Abbas, Clinical Features and diagnosis of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Jan 2009, Uptodate.

21. Para diagnostico de pancreatitis basarse en clínica

22. Puede elevarse amilasa por producción en glan. salivaresKitabchi Abbas, Clinical Features and diagnosis of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Jan 2009, Uptodate.

23. Hallazgos de Laboratorio Kitabchi Abbas, Clinical Features and diadnosis of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Jan 2009, Uptodate.

24. Tratamiento Evaluación inicial examen físico deben centrarse en: Vía aérea, respiración y circulación (ABC) Estado mental Posibles factores precipitantes Estado de hidratación y volemia La evaluación inicial de laboratorio: Glucosa sérica Electrolitos (con cálculo del anión gap), Azoados Hemograma completo con diferencial Uroanálisis y cetonas en la orina con tira reactiva Osmolaridad de plasma Cetonas en suero Gases arteriales Electrocardiograma Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.

25. Tratamiento Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.

26. Tratamiento Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.

27. Tratamiento Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.

28. Tratamiento Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.

29. Tratamiento Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.

30. Tratamiento Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.

31. Tratamiento Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.

32. Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Jan. 2009, Uptodate. Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct. 2009, Uptodate. Diabetes Care, American Diabetes Association, July 2009 Bibliografia