diabetes ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS)

                        DKA                       HHS
glucose          250~600                 600~1200
sodium           125~135                 135~145
K                   normal to high          normal
Mg                normal                      normal
Cl                  normal                      normal
P                   decreased                 normal
Cr                 slightly increased       moderate increased
osmolatiry     300~320                  330~380
keto              ++++                       +/-
HCO3           <15                         normal
PH                6.8~7.3                    >7.3

DKA:
symptoms and signs
abdominal pain, shortness of breath, polyuria, thirst, nausea, vomiting
dehydration, hypotension, tachypnea, tachycardia, abdominal tenderness, lethargy

precipitating factors:
infection
infarction
insulin administration inadequate
drug
pregnency

management
1. confirm the diagnosis
2. admission
3. check: electrolyte, acid-base, renal function
4. fluid supplement: 2~3 L N/S for the first 1~3 hr (10~15 mL/kg/hr), than shifted to half saline (150~300
                              mL/hr), half saline and 5% glucose when sugar < 250 (100~200 mL/ hr)
5. Insulin regular: 0.1U/kg IV or 0.3 U/kg IM STAT, than 0.1 U/kg/hr continuous infusion (do not use 
                           insuline if K<3.3)

HHS
prototype: elderly, a several week history of polyuria, decreased oral intake, weight loss, with confusion,
                 lethargy, and coma
precipitating factors: infarction, infection, compromised water intake

management: as DKA