Diabetic ketoacidosis: blood glucose and pH are different to hyperosmolar nonketotic state.

Clinical bottom line (level 5)

  1. In patients with diabetic ketoacidosis, a high-dose insulin is more likely to cause hypoglycaemia and hypokalaemia, than low-dose insulin.
  2. Patients with diabetic ketoacidosis are more likely to have:
    • lower blood glucose
    • lower pH (ie. more acidosis)
    • more urine ketones
    • lower serum sodium
    than those with hyperglycaemic hyperosmolar nonketotic state.
Kitabchi and Wall: Medical Clinics of North America 1995; 79 (1): 9-37
Expires October 2003

The study

Systematic review of various studies were combined for this review of
  • Patients: diabetic ketoacidosis or hyperglycaemic hyperosmolar nonketotic state
  • Outcome: differential diagnosis


    • Articles found in using , (search terms: ) and

    Selection criteria:
    Appraisal criteria:
    Articles excluded if:


    The evidence

    low dose vs high dose insulin
    Outcome Time to outcome CERRRR
    (95% CI)    		NNT
    (95% CI)
    hypoglycaemia unknown
    (25%)    		 100%
    (% to %)    		 4
    (2 to 13)

    • low dose insulin- initially based on body weight, then 5 units/hour; high dose insulin- initially based on blood glucose, then 50 units/ hour
    • characteristics of diabetic ketoacidosis:
      • plasma glucose >14 mmol/l
      • pH <7.3
      • urine ketone 3 + or more
      • serum sodium 130-140 mEq/l
    • characteristics of hyperglycaemic hyperosmolar nonketotic state:
      • plasma glucose >~34 mmol/l
      • pH >7.3
      • urine ketone 1 + or less
      • serum sodium 145-155 mEq/l
    • High dose insulin also increased hypokalaemia more than low dose insulin.

    Comments

    1. This was a review of previous data, not a systematic review.

    Citation

    1. Kitabchi AE, and Wall BM: Diabetic ketoacidosis. Medical Clinics of North America 1995; 79 (1): 9-37
    Contributor: Clare Wotton and Musab Hayatli, October 2000
    Reviewer:

    Clinical Question.
    Patient Diabetic ketoacidosis or hyperglycaemic hyperosmolar nonketotic state
    Intervention or Exposure blood glucose, pH, serum sodium, ketone bodies
    Outcome differential diagnosis