Diabetic ketoacidosis and hyperosmolar nonketotic state: differences

Hyperosmolar nonketotic refers to hyperosmolar hyperglycemic syndrome. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome are two severe acute complications of diabetes mellitus, with main differences in their metabolic states and clinical presentations.

1. Etiology: DKA commonly occurs in patients with type 1 diabetes, primarily caused by hyperglycemia due to insulin deficiency; while hyperosmolar hyperglycemic syndrome typically occurs in patients with type 2 diabetes and is often associated with elevated blood glucose caused by severe diarrhea, vomiting, and other factors.

2. Symptoms: Clinically, DKA presents with nausea, vomiting, abdominal pain, deep and rapid breathing, Kussmaul respirations, dehydration, and acidosis; whereas hyperosmolar hyperglycemic syndrome is characterized by hyperglycemia and hyperosmolarity, with more pronounced neurological symptoms such as drowsiness, altered consciousness, and even coma.

3. Blood glucose levels: During DKA, blood glucose rises (usually >250 mg/dL), with positive blood and urine ketones and decreased blood pH; in hyperosmolar hyperglycemic syndrome, laboratory tests show extremely high blood glucose levels (often >600 mg/dL), elevated serum sodium and blood osmolality, but no significant elevation in blood ketone levels, with normal or mildly decreased pH.

4. Urine output: In DKA, the 24-hour urine output may be less than 400 ml, while in hyperosmolar hyperglycemic syndrome, it may be less than 100 ml.

Treatment for both conditions involves immediate fluid and electrolyte replacement and insulin administration to control blood glucose; however, correction of acidosis is also required in DKA.