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EvidencebasedmanagementofhyperglycemicemergenciesindiabetesmellitusDiabetesResearchandClinicalPractice

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December2011 Volume94,Issue3,Pages340351

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Evidencebasedmanagementofhyperglycemic
emergenciesindiabetesmellitus

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EbenezerA.Nyenwe

,AbbasE.Kitabchi
DivisionofEndocrinology,DiabetesandMetabolism,UniversityofTennesseeHealthScienceCenter,920Madison
Ave.,Suite300A,Memphis,TN38163,UnitedStates

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DOI:http://dx.doi.org/10.1016/j.diabres.2011.09.012

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Abstract
Thehyperglycemicemergencies,diabeticketoacidosis(DKA)andhyperglycemichyperosmolarstate(HHS)
arepotentiallyfatalcomplicationsofuncontrolleddiabetesmellitus.TheincidenceofDKAandtheeconomic
burdenofitstreatmentcontinuetorise,butitsassociatedmortalityratewhichwasuniformlyhighhas
diminishedremarkablyovertheyears.ThisImprovementinoutcomeislargelyduetobetterunderstandingof
thepathogenesisofhyperglycemicemergenciesandtheapplicationofevidencebasedguidelinesinthe
treatmentofpatients.Inthisarticle,wepresentacriticalreviewoftheevidencebehindtherecommendations
thathaveresultedintheimprovedprognosisofpatientswithhyperglycemiccrises.Asuccinctdiscussionofthe
pathophysiologyandimportantetiologicalfactorsinDKAandHHSareprovidedasaprerequisitefor
understandingtherationalefortheeffectivetherapeuticmaneuversemployedintheseacuteseveremetabolic
conditions.TheevidencefortheroleofpreventivemeasuresinDKAandHHSisalsodiscussed.The
unansweredquestionsandfutureresearchneedsarealsohighlighted.

Keywords:
Diabeticketoacidosis,Hyperglycemichyperosmolarstate,Treatment

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http://www.diabetesresearchclinicalpractice.com/article/S01688227(11)005146/pdf

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