Hyperosmolar hyperglycemic state differential diagnosis: Difference between revisions

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Revision as of 18:40, 24 September 2017

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

Overview

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

Differentiating Hyperosmolar hyperglycemic state from other Diseases

Hyperosmolar hyperglycemic state must be differentiated from other diseases that presents with hyperglycemia, hyperosmolarity, and altered state of conciousness.^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]

Diseases	Laboratory Findings				Physical Examination				History and Symptoms				Other Findings
Diseases	Lab Test 1	Lab Test 2	Lab Test 3	Lab Test 4	Physical Finding 1	Physical Finding 2	Physical Finding 3	Physical Finding 4	Finding 1	Finding 2	Finding 3	Finding 4	Other Findings
Diabetes mellitus	Hyperglycemia: Fasting blood glucose level: >126 mg/dl Random blood glucose level: >200 mg/dl HbA1C: >6.5 %	Urinanalysis may show: Proteinuria Glucosuria	+ antibodies: (Type 1 diabetes) Anti-glutamic acid decarboxylase Anti-islet cell Anti-insulin		Autonomic and peripheral neuropathy	Decreased visual acuity (diabetic retinopathy)	Central obesity Obesity (BMI >25 kg/m2)	Hypertension (Blood pressure >140/90 mmHg)	Family history of diabetes	Sedentary lifestyle Stress	Polyuria Polydipsia Polyphagia Weight loss		History of gestational diabetes Polycystic ovarian syndrome Acanthosis nigricans
Diabetic ketoacidosis	Blood pH < 7.3	Serum bicarbonate < 18 mEq/L	Anion gap > 10 mEq/L	Increased serum osmolarity	May have all clinical features of diabetes mellitus	Hypotension	Tachycardia	Dehydration	May have all clinical features of diabetes mellitus	Younger age with type 1 diabetes mellitus	Prolonged hyperglycemia	Undiagnosed type 1 diabetes mellitus
Impaired glucose tolerance	Hyperglycemia: Fasting blood glucose level: 100-125 mg/dl Oral glucose tolerance test: 140-200 mg/dl				May have all clinical features of diabetes mellitus	Obesity (BMI >25 kg/m2)			May have all clinical features of diabetes mellitus	Family history of diabetes	Sedentary lifestyle


Parameters	Diabetic ketoacidosis (DKA)	Hyperosmolar hyperglycemic state (HHS)

Plasma glucose	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Serum osmolality	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Plasma and urine ketones	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Serum bicarbonate	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Arterial ph	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Anion gap

References

↑ "Diabetic Ketoacidosis: Evaluation and Treatment - American Family Physician".
↑ Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). "Hyperglycemic crises in adult patients with diabetes". Diabetes Care. 32 (7): 1335–43. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.
↑ Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JM, Fournier H, Havrankova J (2003). "Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state". CMAJ. 168 (7): 859–66. PMC 151994. PMID 12668546.
↑ Joseph F, Anderson L, Goenka N, Vora J (2009). "Starvation-induced true diabetic euglycemic ketoacidosis in severe depression". J Gen Intern Med. 24 (1): 129–31. doi:10.1007/s11606-008-0829-0. PMC 2607495. PMID 18975036.
↑ Williams HE (1984). "Alcoholic hypoglycemia and ketoacidosis". Med. Clin. North Am. 68 (1): 33–8. PMID 6361416.
↑ Durnas C, Cusack BJ (1992). "Salicylate intoxication in the elderly. Recognition and recommendations on how to prevent it". Drugs Aging. 2 (1): 20–34. PMID 1554971.
↑ Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G (2000). "Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room". Am. J. Nephrol. 20 (4): 319–23. doi:13607 Check |doi= value (help). PMID 10970986.
↑ Brinkmann B, Fechner G, Karger B, DuChesne A (1998). "Ketoacidosis and lactic acidosis--frequent causes of death in chronic alcoholics?". Int. J. Legal Med. 111 (3): 115–9. PMID 9587792.

Template:WH Template:WS

[urlDiabetic_Ketoacidosis:_Evaluation_and_Treatment_-_American_Family_Physician-1] "Diabetic Ketoacidosis: Evaluation and Treatment - American Family Physician".

[pmid19564476-2] Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). "Hyperglycemic crises in adult patients with diabetes". Diabetes Care. 32 (7): 1335–43. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.

[pmid12668546-3] Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JM, Fournier H, Havrankova J (2003). "Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state". CMAJ. 168 (7): 859–66. PMC 151994. PMID 12668546.

[pmid18975036-4] Joseph F, Anderson L, Goenka N, Vora J (2009). "Starvation-induced true diabetic euglycemic ketoacidosis in severe depression". J Gen Intern Med. 24 (1): 129–31. doi:10.1007/s11606-008-0829-0. PMC 2607495. PMID 18975036.

[pmid6361416-5] Williams HE (1984). "Alcoholic hypoglycemia and ketoacidosis". Med. Clin. North Am. 68 (1): 33–8. PMID 6361416.

[pmid1554971-6] Durnas C, Cusack BJ (1992). "Salicylate intoxication in the elderly. Recognition and recommendations on how to prevent it". Drugs Aging. 2 (1): 20–34. PMID 1554971.

[pmid10970986-7] Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G (2000). "Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room". Am. J. Nephrol. 20 (4): 319–23. doi:13607 Check |doi= value (help). PMID 10970986.

[pmid9587792-8] Brinkmann B, Fechner G, Karger B, DuChesne A (1998). "Ketoacidosis and lactic acidosis--frequent causes of death in chronic alcoholics?". Int. J. Legal Med. 111 (3): 115–9. PMID 9587792.

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@@ Line 9: / Line 9: @@
 ==Differentiating Hyperosmolar hyperglycemic state from other Diseases==
-* Hyperosmolar hyperglycemic state must be differentiated from other diseases that presents with hyperglycemia, hyperosmolarity, and altered state of conciousness.<ref name="urlDiabetic Ketoacidosis: Evaluation and Treatment - American Family Physician">{{cite web |url=http://www.aafp.org/afp/2013/0301/p337.html |title=Diabetic Ketoacidosis: Evaluation and Treatment - American Family Physician |format= |work= |accessdate=}}</ref><ref name="pmid19564476">{{cite journal |vauthors=Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN |title=Hyperglycemic crises in adult patients with diabetes |journal=Diabetes Care |volume=32 |issue=7 |pages=1335–43 |year=2009 |pmid=19564476 |pmc=2699725 |doi=10.2337/dc09-9032 |url=}}</ref><ref name="pmid12668546">{{cite journal |vauthors=Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JM, Fournier H, Havrankova J |title=Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state |journal=CMAJ |volume=168 |issue=7 |pages=859–66 |year=2003 |pmid=12668546 |pmc=151994 |doi= |url=}}</ref><ref name="pmid18975036">{{cite journal |vauthors=Joseph F, Anderson L, Goenka N, Vora J |title=Starvation-induced true diabetic euglycemic ketoacidosis in severe depression |journal=J Gen Intern Med |volume=24 |issue=1 |pages=129–31 |year=2009 |pmid=18975036 |pmc=2607495 |doi=10.1007/s11606-008-0829-0 |url=}}</ref><ref name="pmid6361416">{{cite journal |vauthors=Williams HE |title=Alcoholic hypoglycemia and ketoacidosis |journal=Med. Clin. North Am. |volume=68 |issue=1 |pages=33–8 |year=1984 |pmid=6361416 |doi= |url=}}</ref><ref name="pmid1554971">{{cite journal |vauthors=Durnas C, Cusack BJ |title=Salicylate intoxication in the elderly. Recognition and recommendations on how to prevent it |journal=Drugs Aging |volume=2 |issue=1 |pages=20–34 |year=1992 |pmid=1554971 |doi= |url=}}</ref><ref name="pmid10970986">{{cite journal |vauthors=Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G |title=Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room |journal=Am. J. Nephrol. |volume=20 |issue=4 |pages=319–23 |year=2000 |pmid=10970986 |doi=13607 |url=}}</ref><ref name="pmid9587792">{{cite journal |vauthors=Brinkmann B, Fechner G, Karger B, DuChesne A |title=Ketoacidosis and lactic acidosis--frequent causes of death in chronic alcoholics? |journal=Int. J. Legal Med. |volume=111 |issue=3 |pages=115–9 |year=1998 |pmid=9587792 |doi= |url=}}</ref>
+Hyperosmolar hyperglycemic state must be differentiated from other diseases that presents with hyperglycemia, hyperosmolarity, and altered state of conciousness.<ref name="urlDiabetic Ketoacidosis: Evaluation and Treatment - American Family Physician">{{cite web |url=http://www.aafp.org/afp/2013/0301/p337.html |title=Diabetic Ketoacidosis: Evaluation and Treatment - American Family Physician |format= |work= |accessdate=}}</ref><ref name="pmid19564476">{{cite journal |vauthors=Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN |title=Hyperglycemic crises in adult patients with diabetes |journal=Diabetes Care |volume=32 |issue=7 |pages=1335–43 |year=2009 |pmid=19564476 |pmc=2699725 |doi=10.2337/dc09-9032 |url=}}</ref><ref name="pmid12668546">{{cite journal |vauthors=Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JM, Fournier H, Havrankova J |title=Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state |journal=CMAJ |volume=168 |issue=7 |pages=859–66 |year=2003 |pmid=12668546 |pmc=151994 |doi= |url=}}</ref><ref name="pmid18975036">{{cite journal |vauthors=Joseph F, Anderson L, Goenka N, Vora J |title=Starvation-induced true diabetic euglycemic ketoacidosis in severe depression |journal=J Gen Intern Med |volume=24 |issue=1 |pages=129–31 |year=2009 |pmid=18975036 |pmc=2607495 |doi=10.1007/s11606-008-0829-0 |url=}}</ref><ref name="pmid6361416">{{cite journal |vauthors=Williams HE |title=Alcoholic hypoglycemia and ketoacidosis |journal=Med. Clin. North Am. |volume=68 |issue=1 |pages=33–8 |year=1984 |pmid=6361416 |doi= |url=}}</ref><ref name="pmid1554971">{{cite journal |vauthors=Durnas C, Cusack BJ |title=Salicylate intoxication in the elderly. Recognition and recommendations on how to prevent it |journal=Drugs Aging |volume=2 |issue=1 |pages=20–34 |year=1992 |pmid=1554971 |doi= |url=}}</ref><ref name="pmid10970986">{{cite journal |vauthors=Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G |title=Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room |journal=Am. J. Nephrol. |volume=20 |issue=4 |pages=319–23 |year=2000 |pmid=10970986 |doi=13607 |url=}}</ref><ref name="pmid9587792">{{cite journal |vauthors=Brinkmann B, Fechner G, Karger B, DuChesne A |title=Ketoacidosis and lactic acidosis--frequent causes of death in chronic alcoholics? |journal=Int. J. Legal Med. |volume=111 |issue=3 |pages=115–9 |year=1998 |pmid=9587792 |doi= |url=}}</ref>
-* Hyperosmolar hyperglycemic should also be differentiated from conditions that can cause [[focal neurological signs]] or an [[[altered state of conciousness]] such as [[CNS infections]] and [[stroke]] by doing a simple [[finger stick glucose testing]].
 {|
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
@@ Line 136: / Line 135: @@
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Plasma glucose
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* > 250 mg/dl
+* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* > 600 mg/dl
+* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
 |-
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Serum osmolality
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* Variable
+* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* > 320 mOsm/kg
+* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
 |-
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Plasma and urine ketones
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* Positive
+* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* None or trace
+* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
 |-
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Serum bicarbonate
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* < 18 mEq/L
+* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* > 15 mEq/ L
+* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
 |-
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Arterial ph
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* < 7.30
+* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* > 7.30
+* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Anion gap
+|Anion gap
-| style="padding: 5px 5px; background: #F5F5F5;" |
+|
-* > 12
+|
-| style="padding: 5px 5px; background: #F5F5F5;" |
-* < 12
 |}

Hyperosmolar hyperglycemic state differential diagnosis: Difference between revisions

Revision as of 18:40, 24 September 2017

Overview

Differentiating Hyperosmolar hyperglycemic state from other Diseases

References

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