Symptomatic hyperglycemia

Specialty: Endocrine and metabolic.

• high blood sugar
• symptomatic elevation of blood glucose
• acute hyperglycemic state

Why it occurs

• Decompensated type 1 diabetes mellitus (absolute insulin deficiency that prevents glucose uptake by target tissues and stimulates uncontrolled hepatic gluconeogenesis)
• Decompensated type 2 diabetes mellitus (extreme peripheral insulin resistance combined with a relative secretory deficit, which often presents with profound osmotic dehydration)
• Hyperglycemia induced by glucocorticoids (drugs such as dexamethasone or prednisone that increase hepatic and muscular resistance to insulin)
• Endogenous Cushing syndrome (chronic excess of cortisol with activation of neoglycogenesis)
• Pheochromocytoma (tumor of the adrenal medulla that secretes catecholamines that directly inhibit insulin secretion and stimulate glycogenolysis)
• Acute necrohemorrhagic pancreatitis (massive parenchymal destruction of the pancreas that directly compromises the anatomical and histological integrity of the islets of Langerhans)

Initial workup

Immediate capillary and plasma glycemia to quantify the degree of metabolic deviation; arterial or venous blood gases in order to determine extracellular pH and bicarbonate levels; serum electrolytes (sodium, potassium, chloride) to calculate plasma anion gap; measured and calculated plasma osmolarity; plasma beta-hydroxybutyrate levels; creatinine and urea nitrogen to assess renal function and clearance; and complete blood count to rule out underlying infectious processes as triggers.

Standard management

• Regular human insulin — administered as a continuous intravenous infusion of 0.1 IU/kg/h in states of ketoacidosis to suppress lipolysis and ketogenesis, or subcutaneously according to correction schemes in simple hyperglycemia.
• 0.9% physiological saline solution — initial rapid intravenous infusion of 1000-1500 ml in the first hour to restore the intravascular volume compromised by osmotic diuresis
• Potassium chloride — strict intravenous supplementation if plasma potassium is less than 5.2 mEq/L, postponing insulin administration if potassium is less than 3.3 mEq/L to avoid lethal arrhythmias
• Insulin glargine — long-acting basal analog insulin, started once the patient tolerates the oral route and the transition from continuous intravenous infusion is planned