Clinical Case Database / Category: Case Based Discussion

Diabetic hyperglycaemic crises

Publication details

Dr Joanna Wilson, Dr Barbara Philips, BSc, MD, FRCA, DICM (UK)
Foundation Years Journal, volume 3, issue 10, p.19 (123Doc Education, London, December 2009)


Introduction: type 2 diabetes mellitus is increasing in prevalence and patients may present in hyperglycaemic crisis. We present a case of mixed Diabetic Ketoacidosis (DKA) and Hyperglycaemic Hyperosmolar syndrome (HHS) in a previously unknown diabetic.

Case Presentation: a 49-year-old man presented to the A&E department with polydipsia, polyuria, weight loss and confusion. Biochemical testing revealed evidence of both DKA and HHS. He was transferred to the intensive care unit for further management.

Discussion: it is essential to distinguish between DKA and HHS because of differences in management, with outcome implications. HHS patients are at high risk of cerebral complications and mortality of up to 50% has been reported. Regimens aimed at treating patients with DKA, may exacerbate risk to patients with HHS who should be managed to minimise the risk of cerebral oedema.

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Dr Joanna Wilson

Foundation Year 1
St Georges Intensive Care Unit
St Georges Hospital
Blackshaw Road,
SW17 0QT

Dr Barbara Philips, BSc, MD, FRCA, DICM (UK) (Corresponding author)

Senior Lecturer/Honorary Consultant Intensive Care Medicine
St George’s University of London
Cranmer Terrace
London SW17 0R
tel: 020 8725 2615 (secretary)
fax: 020 8725 0256


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