DKA and hyperosmolar state

DKA: type 1 usually, onset over hours, glucose often 15 to 30 mmol/L, ketones present, pH under 7.30, Kussmaul breathing, fruity breath, abdominal pain. Hyperosmolar state: type 2 usually, onset over days, glucose often above 33 mmol/L, minimal ketones, normal pH, profound dehydration, altered consciousness. Both: fluids first, then insulin infusion, then potassium. Potassium falls sharply as insulin drives it into the cell, even when the initial level looks normal or high. Never start insulin before checking potassium.

Clinical content reviewed by Ducamelle Louis, Registered Nurse