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Management of diabetic emergencies in the critically ill 

Management of diabetic emergencies in the critically ill
Management of diabetic emergencies in the critically ill

Dieter Mesotten

and Sophie Van Cromphaut

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date: 21 May 2022

The three major diabetic emergencies comprise diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar state (HHS), and prolonged hypoglycaemia. These complications are preventable, treatable, and rather infrequently lead to prolonged intensive care (ICU) admission. Hyperglycaemic crises, whether DKA in type 1 diabetics, or HHS in type 2 diabetics, are characterized by moderate to severe hypovolaemia, electrolyte disturbances and a potentially life-threatening trigger. Hence, airway–breathing–circulation securement, diagnosis, and treatment of the underlying condition, as well as fluid resuscitation are the cornerstones of the acute management of DKA and HHS. Currently, a continuous, low (physiological) dose insulin scheme intravenously with omission of the priming bolus is advocated to avoid hypoglycaemia. An evidence-based treatment protocol, and reliable blood glucose and electrolyte measurements are compulsory to safely manage these crises until resolution of ketoacidosis or the hyperosmolar state. Profound hypoglycaemia should be suspected in every coma patient with an indistinct history or on a known regimen of insulin or sulphonylurea/meglitinide. This condition warrants immediate and sufficiently long administration of glucose orally or intravenously, as well as repeated monitoring of blood glucose levels. Alternatively, the counter-regulatory hormone glucagon may be injected intramuscularly in the emergency setting.

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