Hyperglycemic Crises: DKA & HHS – Key Facts

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Question-and-answer flashcards covering definitions, diagnosis, pathophysiology, clinical presentation, treatment steps, monitoring, and common pitfalls for diabetic ketoacidosis (DKA) and hyperosmolar-hyperglycemic state (HHS).

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40 Terms

1
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What plasma glucose level meets the ADA hyperglycemia criterion for DKA?

≥ 200 mg/dL

2
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What plasma glucose level meets the ADA hyperglycemia criterion for HHS?

≥ 600 mg/dL

3
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Which two laboratory values confirm metabolic acidosis in DKA?

Arterial pH < 7.3 and/or serum bicarbonate < 18 mmol/L

4
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What osmolality values define hyperosmolarity in HHS?

Effective serum osmolality > 300 mOsm/kg or total osmolality > 320 mOsm/kg

5
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Which ketone body is preferred for diagnosing DKA?

β-hydroxybutyrate (BHB)

6
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A BHB value of indicates significant ketosis in DKA.

≥ 3.0 mmol/L

7
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List the three ketone bodies produced during DKA.

Acetoacetate, β-hydroxybutyrate, and acetone

8
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Which antihyperglycemic drug class can precipitate euglycemic DKA?

SGLT-2 inhibitors

9
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Name the six precipitating “I’s” of DKA/HHS.

Insulin deficiency, Infection, Inflammation, Intoxication, Infarction, Iatrogenic

10
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Give two classic symptoms common to both DKA and HHS.

Polyuria and polydipsia (weight loss, dehydration, vomiting, weakness are also common)

11
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How does the onset of DKA differ from HHS?

DKA develops within hours to days; HHS develops over days to weeks.

12
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What type of breathing pattern is characteristic of severe DKA?

Kussmaul respirations (deep, rapid, labored)

13
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What is the first therapeutic step in managing DKA/HHS?

Begin IV crystalloid fluid resuscitation.

14
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Typical initial infusion rate for NS or LR in DKA/HHS?

500–1000 mL/hr during the first 2–4 hrs (adjust for comorbidities).

15
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Approximate drop in blood glucose from fluids alone before insulin?

50–70 mg/dL per hour.

16
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When should dextrose (D5 or D10) be added to IV fluids in DKA?

When blood glucose falls below 250 mg/dL.

17
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Target blood-glucose range after adding dextrose in DKA?

150–200 mg/dL.

18
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Target blood-glucose range after adding dextrose in HHS?

200–250 mg/dL.

19
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Why must serum potassium be checked before insulin is started?

Insulin drives K⁺ into cells, risking hypokalemia that can cause arrhythmias and muscle weakness.

20
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Minimum serum K⁺ required before starting insulin therapy?

≥ 3.5 mEq/L.

21
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Therapeutic goal range for serum potassium during treatment?

4–5 mEq/L.

22
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Management step if K⁺ < 3.5 mEq/L at presentation?

Hold insulin, give IV KCl (10–20 mEq/hr) until K⁺ ≥ 3.5 mEq/L.

23
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Recommended initial IV insulin infusion rate for DKA?

0.1 units/kg/hr of regular insulin.

24
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Optional insulin bolus dose often given before the infusion?

0.1 units/kg IV once.

25
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How should the insulin infusion be adjusted when BG < 250 mg/dL in DKA?

Reduce to 0.05 units/kg/hr.

26
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Subcutaneous insulin option for mild DKA?

Rapid-acting insulin 0.1 units/kg SC every 1 hr (or 0.2 units/kg every 2 hrs).

27
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Initial IV insulin infusion rate for HHS?

0.05 units/kg/hr.

28
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List four key labs/parameters to monitor every 2–4 hrs during therapy.

Chem-7 (Na⁺, K⁺, bicarbonate, etc.), BUN/Cr, pH, blood glucose, plus urine output.

29
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Resolution criteria for DKA?

pH > 7.3 or HCO₃ > 18 mmol/L and BHB < 0.6 mmol/L.

30
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Resolution criteria for HHS?

Serum osmolality < 300 mOsm/kg, urine output > 0.5 mL/kg/hr, and BG < 250 mg/dL.

31
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How long should IV insulin overlap with the first SC insulin dose?

1–2 hours to ensure adequate insulin levels.

32
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Give two common clinician errors in DKA/HHS management.

1) Failing to add potassium initially, forcing insulin to be paused later. 2) Forgetting to reduce insulin rate when BG < 250 mg/dL or forgetting to add dextrose.

33
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Why are premixed NS + KCl (± D5) bags advantageous?

They’re stocked on units, saving time and reducing compounding errors.

34
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State the five major goals of therapy in hyperglycemic crises.

Correct fluid deficit, correct hyperglycemia/ketosis, maintain electrolytes, avoid therapy-related complications, treat underlying cause.

35
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Provide the formula for effective serum osmolality.

Effective osmolality = (2 × Na⁺ [mEq/L]) + Glucose (mmol/L).

36
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Convert a glucose of 600 mg/dL to mmol/L.

600 mg/dL ÷ 18 = 33.3 mmol/L.

37
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Which patient population most commonly presents with DKA?

Individuals with type 1 diabetes (though rising in type 2).

38
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Which patient population most commonly presents with HHS?

Elderly patients with type 2 diabetes.

39
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Name two crystalloid solutions commonly used for initial resuscitation.

0.9% NaCl (Normal Saline) and Lactated Ringer’s.

40
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What rare but serious complication can occur if glucose is lowered too quickly?

Cerebral edema.