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Management of Hyperglycemic Crises and Severe Hypoglycemia in the Emergency Department Yasufumi Miyake 1,2 1Emergency and Critical Care Medicine, Showa University School of Medicine 2Emergency Medical Center, Showa University Hospital Keyword: 初期対応 , 糖尿病性ケトアシドーシス , 高浸透圧高血糖症候群 , 乳酸アシドーシス , 低血糖発作 , management , diabetic ketoacidosis (DKA) , hyperosmolar hyperglycemic syndrome (HHS) , lactic acidosis (LA) , severe hypoglycemic attack pp.97-105
Published Date 2014/2/1
DOI https://doi.org/10.11477/mf.1416101710
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Abstract

The morbidity of hyperglycemic crises and acute hypoglycemic attacks in patients with diabetes mellitus has been increasing for the past several decades. One of the reasons for this is the increase in the number of patients with diabetes. The increased proportion of aging and isolation in society is another reason.

The author has discussed patients with these complaints: their epidemiology, pathophysiology, and management in the emergency department. Hyperglycemic crises include diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic syndrome (HHS), and lactic acidosis (LA). Younger patients with type 1 diabetes suffer from DKA; inappropriate insulin therapy or infection is usually the trigger. Older patients with type 2 diabetes are at risk of HHS in the course of sepsis or in the perioperative period. The treatment of both types of patients is common. Sufficient amount of intravenous extracellular fluid and constant infusion of insulin are essential. The development of LA is not associated with the use of metformin, but with the severity of the pre-existing disease. Early recognition and aggressive treatment is vital to improving the prognosis of hyperglycemic emergencies and severe hypoglycemic episodes.


Copyright © 2014, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1344-8129 印刷版ISSN 1881-6096 医学書院

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