Hyperglycemic Crisis
Van Ness-Otunnu R, Hack JB. J Emerg Med. 2013;45(5):797-805
Key Points:
No longer recommend bolus for insulin
Insulin drip at 0.14 units/kg/hr
No K+ initially if serum level is 3.3-5.2 mEq/L
If the K+ is < 3.3 then give K+ before starting insulin
Criteria for DKA include: blood glucose level > 250 mg/dL, moderate ketonuria or ketonemia, arterial pH < 7.3, and bicarbonate < 15 mEq/L
The criteria for HHS are altered sensorium, a glucose level greater than 600 mg/dL, minimal or no ketonemia, serum osmolality greater than 320 MOsm/kg, arterial pH > 7.3, and bicarbonate > 15 mEq/L
PMID: 23786780
