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British Medical Bulletin 45:242-263 (1989)
© 1989 The British Council

research-article

Diabetic emergencies

K G M M Alberti

Department of Medicine, University of Newcastle upon Tyne Newcastle upon Tyne, UK

Abstract

Diabetic emergencies continue to be a significant cause of premature death in patients with diabetes. They include the diabetic comas (hypoglycaemia, severe diabetic ketoacidosis, hyperosmolar hyperglycaemic non-ketotic coma, lactic acidosis), emergency surgery and myocardial infarction. There is still considerable avoidable morbidity and mortality during treatment, and as a result of misdiagnosis. Simple guidelines are thus needed for the general practitioner and admitting physician to improve management.

Hypoglycaemia is far the commonest diabetic emergency, and is relatively easy to diagnose and treat. Delays in treatment are potentially damaging and largely unnecessary Diabetic ketoacidosis is still relatively common but is often preventable. Initial treatment for this and hyperosmolar non-ketotic coma is rehydration This is followed by IM or IV infusion of moderate amounts of insulin, early potassium replacement, and alkali only if the acidaemia is severe Lactic acidosis requires mainly rigorous alkalinisation but is very rare. The metabolic derangements in emergency surgery and myocardial infarction are best treated by combined glucose, potassium and insulin infusions. In all cases treatment is easiest and probably more successful if consistent simple guidelines are provided


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