Obtaining blood tests may be time-consuming. Because ETCO 2 closely approximates arterial CO 2 tension, it can potentially be used to predict the presence or absence of DKA. In response to the decreased serum pH that is associated with a decrease in serum bicarbonate, an increase would occur in alveolar minute ventilation with a corresponding decrease in arterial CO 2 tension. The partial pressure of CO 2 at end expiration is termed end tidal CO 2 (ETCO 2). It monitors the partial pressure of carbon dioxide (CO 2) in respiratory gases. Capnography provides an indirect means to detect metabolic acidosis. While insulin is not harmful in severe hyperglycemia, patients may achieve euglycaemia with fluid resuscitation alone and an insulin drip is not needed. The administration of regular insulin to DKA patients via continuous intravenous infusion or by frequent subcutaneous or intramuscular injections is the mainstay of treatment and is needed to stop the breakdown of fatty acids into ketones and to revert the acidotic state. All hyperglycaemic states require fluid resuscitation. HHS is also characterized by neurological impairment, with the presentation ranging from altered mental status to stupor. HHS is defined as a state of severe hyperglycaemia without ketosis, with a glucose >600 mg/dL but with levels frequently exceeding 1000 mg/d. DKA is a potentially life-threatening emergency characterized by hyperglycaemia, metabolic acidosis and ketonemia along with severe electrolyte abnormalities. Acute complications of diabetes include severe hyperglycaemia, diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS). Diabetes mellitus is the most common endocrine disease in the world.
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