핵심 개념
De-emphasizing glucose in DKA diagnosis, new guidelines aim to improve outcomes for hyperglycemic emergencies in adults with diabetes.
초록
The upcoming joint society statement on hyperglycemic emergencies in adults with diabetes will introduce significant updates to the diagnostic criteria for diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). The new guidelines emphasize the risks associated with the hybrid presentation of these conditions, urge clinicians to investigate precipitating causes, and provide detailed recommendations for diagnosis and management. Key changes include revised definitions for DKA and HHS, emphasizing beta-hydroxybutyrate testing, and updated criteria for resolution and acute management. The guidelines also focus on mitigating complications, preventing recurrence, and addressing social determinants of health to improve patient outcomes.
Structure:
- Introduction to New Guidelines
- Focus on Hybrid Presentation of Hyperglycemic Emergencies
- Revised Definitions for DKA and HHS
- Acute Management Recommendations
- Mitigating Complications and Preventing Recurrence
- Addressing Social Determinants of Health
통계
The hyperglycemia cutoff for DKA is now lowered to 200 mg/dL from the previous 250 mg/dL.
Approximately 10% of DKA cases occur with euglycemia or near-normoglycemia.
The new guidelines recommend a beta-hydroxybutyrate cutoff of ≥ 3.0 mmol/L for assessing ketosis in DKA.
Metabolic acidosis is defined as a pH < 7.3 and/or a bicarbonate concentration < 18 mmol/L.
Criteria for resolution of DKA include a venous pH of ≥ 7.3, bicarbonate > 18 mmol/L, ketones < 0.6 mmol/L, and glucose ideally < 200 mg/dL.
인용구
"I liked the proposal to eliminate the anion gap in decision-making and to focus on measurement of blood ketones, principally beta-hydroxybutyrate, in the diagnosis of DKA and monitoring the effect of treatment." - Charles Alexander, MD
"If someone is on an SGLT2 inhibitor, there is no need to look at blood glucose levels, which may be normal or near normal in the setting of DKA." - Charles Alexander, MD