Hyperosmolar hyperglycemic state risk factors: Difference between revisions

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{{CMG}}; {{AE}} {{HS}}
{{CMG}}; {{AE}} {{HS}}
==Overview==
==Overview==
Common risk factors in the development of hyperosmolar hyperglycemic state (HHS) are old age, high mean [[HbA1c|glycosylated hemoglobin A1c]], acute stresses like [[infections]], [[myocardial infarction]], [[pancreatitis]], poor [[diabetes]] control, noncompliance with [[insulin]], poor [[cardiac]] and [[renal]] function and low socioeconomic status.
Common risk factors in the development of hyperosmolar hyperglycemic state (HHS) are old age, high mean [[HbA1c|glycosylated hemoglobin A1C]], acute stresses like [[infections]], [[myocardial infarction]], [[pancreatitis]], poor [[diabetes]] control, noncompliance with [[insulin]], poor [[cardiac]] and [[renal]] function and low socioeconomic status.


==Risk Factors==
==Risk Factors==
=== Factors increasing risk ===
=== Factors increasing risk ===
==== Common risk factors: ====
The following factors are associated with an increased risk of hyperosmolar hyperglycemic state (HHS):<ref name="pmid23760624">{{cite journal |vauthors=Weinstock RS, Xing D, Maahs DM, Michels A, Rickels MR, Peters AL, Bergenstal RM, Harris B, Dubose SN, Miller KM, Beck RW |title=Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry |journal=J. Clin. Endocrinol. Metab. |volume=98 |issue=8 |pages=3411–9 |year=2013 |pmid=23760624 |doi=10.1210/jc.2013-1589 |url=}}</ref><ref name="urlClinical and socio-demographic factors associated with diabetic ketoacidosis hospitalization in adults with Type 1 diabetes - Butalia - 2013 - Diabetic Medicine - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1111/dme.12127/full |title=Clinical and socio-demographic factors associated with diabetic ketoacidosis hospitalization in adults with Type 1 diabetes - Butalia - 2013 - Diabetic Medicine - Wiley Online Library |format= |work= |accessdate=}}</ref><ref name="pmid23469984">{{cite journal |vauthors=Cengiz E, Xing D, Wong JC, Wolfsdorf JI, Haymond MW, Rewers A, Shanmugham S, Tamborlane WV, Willi SM, Seiple DL, Miller KM, DuBose SN, Beck RW |title=Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry |journal=Pediatr Diabetes |volume=14 |issue=6 |pages=447–54 |year=2013 |pmid=23469984 |pmc=4100244 |doi=10.1111/pedi.12030 |url=}}</ref><ref name="urlDiabetes Care">{{cite web |url=http://care.diabetesjournals.org/content/38/8/1536?ijkey=23f3ba34402910165dc307cff987df5ff32f394b&keytype2=tf_ipsecsha |title=Diabetes Care |format= |work= |accessdate=}}</ref><ref name="pmid22230097">{{cite journal |vauthors=Low JC, Felner EI, Muir AB, Brown M, Dorcelet M, Peng L, Umpierrez GE |title=Do obese children with diabetic ketoacidosis have type 1 or type 2 diabetes? |journal=Prim Care Diabetes |volume=6 |issue=1 |pages=61–5 |year=2012 |pmid=22230097 |pmc=3746511 |doi=10.1016/j.pcd.2011.11.001 |url=}}</ref><ref name="pmid8944212">{{cite journal |vauthors=Katz JR, Edwards R, Khan M, Conway GS |title=Acromegaly presenting with diabetic ketoacidosis |journal=Postgrad Med J |volume=72 |issue=853 |pages=682–3 |year=1996 |pmid=8944212 |pmc=2398638 |doi= |url=}}</ref><ref name="pmid16027420">{{cite journal |vauthors=Burzynski J |title=DKA and thrombosis |journal=CMAJ |volume=173 |issue=2 |pages=132; author reply 132–3 |year=2005 |pmid=16027420 |pmc=1174837 |doi=10.1503/cmaj.1050103 |url=}}</ref><ref name="pmid24748799">{{cite journal |vauthors=Jovanovic A, Stolic RV, Rasic DV, Markovic-Jovanovic SR, Peric VM |title=Stroke and diabetic ketoacidosis--some diagnostic and therapeutic considerations |journal=Vasc Health Risk Manag |volume=10 |issue= |pages=201–4 |year=2014 |pmid=24748799 |pmc=3986295 |doi=10.2147/VHRM.S59593 |url=}}</ref><ref name="pmid20829623">{{cite journal |vauthors=Pivonello R, De Leo M, Vitale P, Cozzolino A, Simeoli C, De Martino MC, Lombardi G, Colao A |title=Pathophysiology of diabetes mellitus in Cushing's syndrome |journal=Neuroendocrinology |volume=92 Suppl 1 |issue= |pages=77–81 |year=2010 |pmid=20829623 |doi=10.1159/000314319 |url=}}</ref><ref name="pmid4205898">{{cite journal |vauthors=Pasternak DP |title=Hemochromatosis presenting as diabetic ketoacidosis with extreme hyperglycemia |journal=West. J. Med. |volume=120 |issue=3 |pages=244–6 |year=1974 |pmid=4205898 |pmc=1129403 |doi= |url=}}</ref><ref name="pmid12954957">{{cite journal |vauthors=Kamalakannan D, Baskar V, Barton DM, Abdu TA |title=Diabetic ketoacidosis in pregnancy |journal=Postgrad Med J |volume=79 |issue=934 |pages=454–7 |year=2003 |pmid=12954957 |pmc=1742779 |doi= |url=}}</ref>
The following factors are associated with an increased risk of hyperosmolar hyperglycemic state (HHS):<ref name="pmid23760624">{{cite journal |vauthors=Weinstock RS, Xing D, Maahs DM, Michels A, Rickels MR, Peters AL, Bergenstal RM, Harris B, Dubose SN, Miller KM, Beck RW |title=Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry |journal=J. Clin. Endocrinol. Metab. |volume=98 |issue=8 |pages=3411–9 |year=2013 |pmid=23760624 |doi=10.1210/jc.2013-1589 |url=}}</ref><ref name="urlClinical and socio-demographic factors associated with diabetic ketoacidosis hospitalization in adults with Type 1 diabetes - Butalia - 2013 - Diabetic Medicine - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1111/dme.12127/full |title=Clinical and socio-demographic factors associated with diabetic ketoacidosis hospitalization in adults with Type 1 diabetes - Butalia - 2013 - Diabetic Medicine - Wiley Online Library |format= |work= |accessdate=}}</ref><ref name="pmid23469984">{{cite journal |vauthors=Cengiz E, Xing D, Wong JC, Wolfsdorf JI, Haymond MW, Rewers A, Shanmugham S, Tamborlane WV, Willi SM, Seiple DL, Miller KM, DuBose SN, Beck RW |title=Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry |journal=Pediatr Diabetes |volume=14 |issue=6 |pages=447–54 |year=2013 |pmid=23469984 |pmc=4100244 |doi=10.1111/pedi.12030 |url=}}</ref><ref name="urlDiabetes Care">{{cite web |url=http://care.diabetesjournals.org/content/38/8/1536?ijkey=23f3ba34402910165dc307cff987df5ff32f394b&keytype2=tf_ipsecsha |title=Diabetes Care |format= |work= |accessdate=}}</ref><ref name="pmid22230097">{{cite journal |vauthors=Low JC, Felner EI, Muir AB, Brown M, Dorcelet M, Peng L, Umpierrez GE |title=Do obese children with diabetic ketoacidosis have type 1 or type 2 diabetes? |journal=Prim Care Diabetes |volume=6 |issue=1 |pages=61–5 |year=2012 |pmid=22230097 |pmc=3746511 |doi=10.1016/j.pcd.2011.11.001 |url=}}</ref><ref name="pmid8944212">{{cite journal |vauthors=Katz JR, Edwards R, Khan M, Conway GS |title=Acromegaly presenting with diabetic ketoacidosis |journal=Postgrad Med J |volume=72 |issue=853 |pages=682–3 |year=1996 |pmid=8944212 |pmc=2398638 |doi= |url=}}</ref><ref name="pmid16027420">{{cite journal |vauthors=Burzynski J |title=DKA and thrombosis |journal=CMAJ |volume=173 |issue=2 |pages=132; author reply 132–3 |year=2005 |pmid=16027420 |pmc=1174837 |doi=10.1503/cmaj.1050103 |url=}}</ref><ref name="pmid24748799">{{cite journal |vauthors=Jovanovic A, Stolic RV, Rasic DV, Markovic-Jovanovic SR, Peric VM |title=Stroke and diabetic ketoacidosis--some diagnostic and therapeutic considerations |journal=Vasc Health Risk Manag |volume=10 |issue= |pages=201–4 |year=2014 |pmid=24748799 |pmc=3986295 |doi=10.2147/VHRM.S59593 |url=}}</ref><ref name="pmid20829623">{{cite journal |vauthors=Pivonello R, De Leo M, Vitale P, Cozzolino A, Simeoli C, De Martino MC, Lombardi G, Colao A |title=Pathophysiology of diabetes mellitus in Cushing's syndrome |journal=Neuroendocrinology |volume=92 Suppl 1 |issue= |pages=77–81 |year=2010 |pmid=20829623 |doi=10.1159/000314319 |url=}}</ref><ref name="pmid4205898">{{cite journal |vauthors=Pasternak DP |title=Hemochromatosis presenting as diabetic ketoacidosis with extreme hyperglycemia |journal=West. J. Med. |volume=120 |issue=3 |pages=244–6 |year=1974 |pmid=4205898 |pmc=1129403 |doi= |url=}}</ref><ref name="pmid12954957">{{cite journal |vauthors=Kamalakannan D, Baskar V, Barton DM, Abdu TA |title=Diabetic ketoacidosis in pregnancy |journal=Postgrad Med J |volume=79 |issue=934 |pages=454–7 |year=2003 |pmid=12954957 |pmc=1742779 |doi= |url=}}</ref>
* Old age
* Old age
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** [[Hemochromatosis]]
** [[Hemochromatosis]]
** [[Pregnancy]]
** [[Pregnancy]]
==== Less common risk factors: ====
*[[Heatstroke]]
*[[Heatstroke]]
*[[Hypothermia]]
*[[Hypothermia]]
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{{WS}}
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[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Up-To-Date]]
​
[[Category:Emergency medicine]]

Latest revision as of 15:36, 23 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

Overview

Common risk factors in the development of hyperosmolar hyperglycemic state (HHS) are old age, high mean glycosylated hemoglobin A1C, acute stresses like infections, myocardial infarction, pancreatitis, poor diabetes control, noncompliance with insulin, poor cardiac and renal function and low socioeconomic status.

Risk Factors

Factors increasing risk

Common risk factors:

The following factors are associated with an increased risk of hyperosmolar hyperglycemic state (HHS):[1][2][3][4][5][6][7][8][9][10][11]

Less common risk factors:

Factors decreasing risk

The following factors are associated with a reduced risk of hyperosmolar hyperglycemic state (HHS):[12]

  • Optimum management of diabetes
  • Optimum fluid intake
  • Adequate renal functions
  • Adequate cardiac functions
  • Higher education level of patient
  • Higher education level of care giver

References

  1. ↑ Weinstock RS, Xing D, Maahs DM, Michels A, Rickels MR, Peters AL, Bergenstal RM, Harris B, Dubose SN, Miller KM, Beck RW (2013). "Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry". J. Clin. Endocrinol. Metab. 98 (8): 3411–9. doi:10.1210/jc.2013-1589. PMID 23760624.
  2. ↑ "Clinical and socio-demographic factors associated with diabetic ketoacidosis hospitalization in adults with Type 1 diabetes - Butalia - 2013 - Diabetic Medicine - Wiley Online Library".
  3. ↑ Cengiz E, Xing D, Wong JC, Wolfsdorf JI, Haymond MW, Rewers A, Shanmugham S, Tamborlane WV, Willi SM, Seiple DL, Miller KM, DuBose SN, Beck RW (2013). "Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry". Pediatr Diabetes. 14 (6): 447–54. doi:10.1111/pedi.12030. PMC 4100244. PMID 23469984.
  4. ↑ "Diabetes Care".
  5. ↑ Low JC, Felner EI, Muir AB, Brown M, Dorcelet M, Peng L, Umpierrez GE (2012). "Do obese children with diabetic ketoacidosis have type 1 or type 2 diabetes?". Prim Care Diabetes. 6 (1): 61–5. doi:10.1016/j.pcd.2011.11.001. PMC 3746511. PMID 22230097.
  6. ↑ Katz JR, Edwards R, Khan M, Conway GS (1996). "Acromegaly presenting with diabetic ketoacidosis". Postgrad Med J. 72 (853): 682–3. PMC 2398638. PMID 8944212.
  7. ↑ Burzynski J (2005). "DKA and thrombosis". CMAJ. 173 (2): 132, author reply 132–3. doi:10.1503/cmaj.1050103. PMC 1174837. PMID 16027420.
  8. ↑ Jovanovic A, Stolic RV, Rasic DV, Markovic-Jovanovic SR, Peric VM (2014). "Stroke and diabetic ketoacidosis--some diagnostic and therapeutic considerations". Vasc Health Risk Manag. 10: 201–4. doi:10.2147/VHRM.S59593. PMC 3986295. PMID 24748799.
  9. ↑ Pivonello R, De Leo M, Vitale P, Cozzolino A, Simeoli C, De Martino MC, Lombardi G, Colao A (2010). "Pathophysiology of diabetes mellitus in Cushing's syndrome". Neuroendocrinology. 92 Suppl 1: 77–81. doi:10.1159/000314319. PMID 20829623.
  10. ↑ Pasternak DP (1974). "Hemochromatosis presenting as diabetic ketoacidosis with extreme hyperglycemia". West. J. Med. 120 (3): 244–6. PMC 1129403. PMID 4205898.
  11. ↑ Kamalakannan D, Baskar V, Barton DM, Abdu TA (2003). "Diabetic ketoacidosis in pregnancy". Postgrad Med J. 79 (934): 454–7. PMC 1742779. PMID 12954957.
  12. ↑ "Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review | The BMJ".

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