What is a ketotic

Diabetic ketoacidosis and non-ketoacidotic hyperosmolar diabetic coma

The lethality of the treatment of diabetic coma has continuously decreased in the last decades, especially due to the detection and avoidance of errors in previous forms of therapy. The most important therapeutic measure in the acute stage is volume substitution, with Ringer's solution and physiological saline solution being the most suitable. Insulin substitution should be done carefully and very cautiously. In most cases, a very low dose of insulin therapy is sufficient to keep blood sugar levels down by no more than 50 mg / dl per hour. Other fixed components of the treatment are a substitution of potassium salt and thrombosis prophylaxis with heparin. Hydrogen carbonate is indicated in special cases with cardiovascular depression, cardiac arrhythmias, or hyperkalemia. Over-therapy must be avoided at all times during therapy in order not to induce iatrogenic complications. Taking this approach into account, a very low mortality rate can thus be achieved, especially in younger patients.


We would like to thank Ms. Mechthild Kretlow for her support in preparing the manuscript.

Therapy of diabetic ketoacidosis and non-ketoacidotic hyperosmolar coma

This review summarizes the current therapeutic approach to diabetic ketoacidosis and hyperosmolar coma. The main outline focuses on emergency treatment and management in the intensive care unit, particularly with regard to volume and insulin therapy and potassium replacement. The basic concepts of low and very low insulin therapy are presented, with special emphasis on the pathogenesis and avoidance of the disequilibrium syndrome. Furthermore, the indications for bicarbonate therapy as well as phosphate and magnesium replacement in diabetic ketoacidosis are critically discussed. This practically oriented review incorporates the current guidelines of the German diabetes association on this topic.

With present-day treatment options the therapeutic goal of a low mortality, depending on the underlying illness, can be achieved.

Keywords: diabetic ketoacidosis, non-ketoacidotic hyperosmolar coma, cerebral edema, insulin, intensive care


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Prof. Dr. med. Johannes Hensen (Head Physician), Theodoros Thomas, Jens Müller-Ziehm, Medical Clinic, Hannover Nordstadt Clinic, Halthoffstrasse 41, 30167 Hannover, email: [email protected]