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Predisposing or precipitating factors for diabetic ketoacidosis and hyperosmolar hyperglycemic state

Predisposing or precipitating factors for diabetic ketoacidosis and hyperosmolar hyperglycemic state
DKA HHS

Inadequate insulin treatment or nonadherence

New-onset diabetes (20 to 25%)

Acute illness
  • Infection (30 to 40%)
  • Stroke or transient ischemic attack
  • Myocardial infarction
  • Acute pancreatitis

Drugs/therapy

  • Clozapine or olanzapine
  • Cocaine
  • Glucocorticoids
  • Lithium
  • SGLT2 inhibitors
  • Terbutaline

Inadequate insulin treatment or nonadherence (21 to 41%)

Acute illness
  • Infection (32 to 60%)
  • Pneumonia
  • Urinary tract infection
  • Sepsis
  • Stroke or transient ischemic attack
  • Myocardial infarction
  • Acute pancreatitis
  • Acute pulmonary embolus
  • Intestinal obstruction
  • Mesenteric thrombosis
  • Kidney failure
  • Heat stroke
  • Hypothermia
  • Subdural hematoma
  • Severe burns

Endocrine

  • Acromegaly
  • Thyrotoxicosis
  • Cushing syndrome

Drugs/therapy

  • Beta-adrenergic blockers
  • Calcium channel blockers
  • Chlorpromazine
  • Cimetidine
  • Clozapine
  • Diazoxide
  • Diuretics
  • Glucocorticoids
  • Immunosuppressive agents
  • L-asparaginase
  • Loxapine
  • Olanzapine
  • Phenytoin
  • Total parenteral nutrition

Previously undiagnosed diabetes mellitus
The most common precipitating factors for DKA are infection (30 to 40%) and new-onset diabetes (20 to 25%), and the most common precipitating factors for HHS are inadequate insulin treatment or nonadherence (21 to 41%) and infection (32 to 60%).
DKA: diabetic ketoacidosis; HHS: hyperosmolar hyperglycemic state; SGLT2: sodium-glucose cotransporter 2.
Data from: Kitabchi AE, Umpierrez GE, Murphy MB, et al. Management of hyperglycemic crises in patients with diabetes mellitus (Technical Review). Diabetes Care 2001; 24:131.
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