DR DIYAOLU F.P. SR, E.D.M. UNIT. LUTH.

OUTLINE: Manifestations. Symptoms Signs Precipitants Complications

CLINICAL FEATURES  DIABETIC KETOACIDOSIS  HYPERGLYCAEMIC HYPEROSMOLAR STATE

CLINICAL FEATURES Can be as a result of:  Hyperglycaemia (Osmosis) with or without ketosis  Precipitants  Complications

CLINICAL FEATURES DKAHHS AGEYOUNGELDERLY ONSETRAPIDINSIDUOUS SYMPTOMS Thirst +++ Polyuria+++ Weight Loss+_

SYMPTOMS DKAHHS Nausea/vomiting+- Abdominal pain+- Muscle Cramps++ Confusion+++ Seizures(Rare)+++ Mental stupor+++ Coma+++

SIGNS DKAHHS  Dehydration+++  Hypothermia+++  Kussmaul Respiration +-  Acetone breath+-  Tachycardia+++  Neurological deficits +++  Paralytic ileus + abdominal distension +-

PRECIPITANTS DKAHHS  PRECIPITANT Inadequate insulin administration +++ Infection(30-40%) (pneumonia/UTI/gastroe nteritis/sepsis) ++ Infarction (cerebral, mesenteric, coronary, peripheral) ++ New onset Diabetes+++ Emotional stress+++

PRECIPITANTS(CONT’D) PRECIPITANTDKAHHS Surgery++ Pregnancy + + Drugs/Medications Antipsychotics++ Anti retrovirals++

COMPLICATIONS COMPLICATIONDKAHHS Cerebral Oedema+++ Adult respiratory distress syndrome ++ Thromboembolism+++ Aspiration Pneumonitis+++ Stroke+++ Hypoglycemia(Features of) ++ Hypokalaemia(Features of) ++ Fliud Overload++

DKAHHSP VALUE Age53.9(14.1)54.1(16.3)>0.05 Sex(F:M)41: Seizures03(17%) Altered mentation18(19%)8(47%) Mean blood glucose22.8(5.9)38.3(3.7%) Presence of hypertension 29(31%)5(30%)>0.05 DM duration7(9.8%)5.4(7.3)>0.05 Clinical characteristics of the subjects with hyperglycaemic emergencies Ogbera et al. BMC Endocrine Disorders :9 doi: /

SUMMARY; Clinical manifestations tend to be as a result of Hyperglycaemia-Osmotic, Ketosis, Precipitants and Complications. Neurologic features commoner in HHS while Gastrointestinal manifestation suggests more of DKA Presence of fever highly suggests infection as precipitants as hypothermia is a common presentation

REFERENCES: George S. Eisenbarth, John B. Buse Acute Diabetic Complications :Diabetic ketoacidosis. Williams textbook of Endocrinology 12 th edition, chapter 32, page Saunders Elsevier publishers,2011. Ogbera et al. BMC Endocrine Disorders :9 doi: / Anumah F.O, Ohwovoriole A.E. Ethnicity and Disease,2008