Management of acute hyperglycemic emergencies: Focus on diabetic ketoacidosis

摘要

Diabetic ketoacidosis is characterized by a decrease in effective insulin concentration and an increase in the concentration of counterregulatory hormones, including catecholamines, cortisol, glucagon, and growth hormone, which leads to the hallmark signs of DKA, such as anion gap metabolic acidosis, hyperglycemia, and elevated levels of ketones in the blood. Undiagnosed or untreated DKA can result in severe metabolic derangements, altered mental status, coma, and death. The causes of DKA include infection, discontinuation of or inadequate insulin therapy, pancreatitis, myocardial infarction, cerebrovascular accident, and the use of drugs such as corticosteroids, thiazide diuretics, sympathomimetic agents, antipsychotic agents, and pentamidine.3 This column discusses the pharmacological treatment of DKA