EM · Diabetic emergencies

DKA, HHS and hypoglycaemia

Also known as Diabetic ketoacidosis · Hyperosmolar hyperglycaemic state · Severe hypoglycaemia · Diabetic emergencies

The three diabetic emergencies — diabetic ketoacidosis (the ketosis, the metabolic acidosis and the hyperglycaemia), hyperosmolar hyperglycaemic state (the severe hyperglycaemia, the marked hyperosmolality, minimal ketosis) and severe hypoglycaemia (third-party assistance needed). The Fellowship-critical doses and rationale: fluid resuscitation and the fixed-rate insulin infusion at 0.1 units/kg/h for DKA with glucose added to the fluid once the blood glucose falls under 14 mmol/L, potassium replacement guided by levels; the HHS pathway with 0.9 per cent saline as the principal fluid, insulin withheld until osmolality stops falling on fluids alone, and an osmolality fall of 3 to 8 mOsm/kg/h; and the hypoglycaemia rescue (glucose 25 g IV or glucagon without intravenous access). ACEM-primary, globally tagged.