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

2. OUTLINE: Manifestations. Symptoms Signs Precipitants Complications

3. CLINICAL FEATURES  DIABETIC KETOACIDOSIS  HYPERGLYCAEMIC HYPEROSMOLAR STATE

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

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

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

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

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

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

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

11. DKAHHSP VALUE Age53.9(14.1)54.1(16.3)>0.05 Sex(F:M)41:5311.60.001 Seizures03(17%) Altered mentation18(19%)8(47%) Mean blood glucose22.8(5.9)38.3(3.7%)0.00001 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 2009 9:9 doi:10.1186/1472-6823-9-9

12. 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

13. REFERENCES: George S. Eisenbarth, John B. Buse Acute Diabetic Complications :Diabetic ketoacidosis. Williams textbook of Endocrinology 12 th edition, chapter 32, page 1453. Saunders Elsevier publishers,2011. Ogbera et al. BMC Endocrine Disorders 2009 9:9 doi:10.1186/1472-6823-9-9 Anumah F.O, Ohwovoriole A.E. Ethnicity and Disease,2008