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Monthly Archives: November 2013

The Management of Hyperglycemic Crises in Diabetes


Diabetic ketoacidosis (DKA) and the hyperosmolar hyperglycemic state (HHS) are the two most serious acute metabolic complications of diabetes. The triad of uncontrolled hyperglycemia, metabolic acidosis (SAG elevated metabolic acidosis), and increased total body ketone concentration characterizes DKA. HHS is characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of significant ketoacidosis. Pathogenesis DKA […]

The Management of Metabolic Alkalosis


Metabolic alkalosis is a simple acid-base disorder that presents as alkalemia (increased arterial pH) with an increase in plasma bicarbonate. It is an extremely common entity in hospitalized patients with acid-base disturbances. Under normal circumstances, the kidney is readily able to excrete an alkali load. Pathophysiology The evaluation of metabolic alkalosis must consider two separate […]

The Management of Acute Severe Metabolic Acidosis


For life-threatening acute metabolic acidosis (plasma bicarbonate of 8 mEq/L and pH <7.20) often requires intravenous alkali therapy. Although conventional wisdom recommends the use of alkali replacement in patients with severe acidemia because of the deleterious effects of acidemia on circulatory function, studies have not demonstrated that its administration improves patient outcomes. Pathophysiology Metabolic acidosis […]