Endocrine Emergencies: DKA vs. HHS
Comprehensive comparison of Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS), potassium replacement protocols, and fluid resuscitation priorities.
High-Yield Clinical Takeaways & NCLEX Priorities
- DKA (Type 1 DM): Rapid onset, glucose 250–500 mg/dL, positive serum ketones, metabolic acidosis (pH < 7.30), Kussmaul respirations, fruity breath.
- HHS (Type 2 DM): Insidious onset, severe hyperglycemia (glucose > 600 mg/dL), negative/trace ketones, severe dehydration and hyperosmolality (> 320 mOsm/kg).
- First priority in both is rapid IV fluid resuscitation (0.9% Normal Saline) to restore circulating volume prior to insulin administration.
- Check serum potassium before starting regular insulin drip; if K+ < 3.3 mEq/L, hold insulin and infuse potassium to avoid life-threatening cardiac arrest.
1. Fluid & Electrolyte Resuscitation Hierarchy
Intravenous rehydration expands extracellular fluid volume and reduces counter-regulatory stress hormones. Regular insulin must be given via infusion pump. Once blood glucose falls to 200–250 mg/dL, add 5% Dextrose (D5W) to the IV fluids to prevent cerebral edema and acute hypoglycemia.
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