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January 13, 1975

Hyperglycemic and Hypoglycemic Crises

Author Affiliations

From the Endocrine-Metabolic Unit, Peter Bent Brigham Hospital, and Harvard Medical School, and the Boston Hospital for Women (Dr. Shane), Boston. Dr. Himathongkam is a fellow of the Population Council.

JAMA. 1975;231(2):185-187. doi:10.1001/jama.1975.03240140043028

METABOLIC abnormalities involving glucose metabolism are the most common endocrine dysfunctions seen in internal medicine. We will cover the three most important abnormalities of glucose metabolism that constitute medical emergencies. As a general rule, it is stressed that in all comatose patients where the diagnosis is not known, the blood glucose level should be measured.

Diabetic Ketoacidosis 

Clinical Presentation.—  Diabetic ketoacidosis is a state of severe insulin deficiency characterized by hyperglycemia, systemic acidosis, and hyperketonemia. The diabetic patient is unable to incorporate glucose into metabolic pathways because of insulin deficiency. There is also an increased mobilization of fat and protein stores secondary to insulin deficiency. The products of these stores subsequently accumulate in the form of the ketoacids. The resulting systemic acidosis and osmotic diuresis cause severe derangements in electrolyte and acid-base composition as the obligatory renal loss of glucose and ketoacids results in increased cation excretion. The fluid loss