Vital Signs in Impending Hyperglycemic Crisis Are NOT Stable
No, vital signs are typically unstable in patients with impending hyperglycemic crisis, with tachycardia and hypotension being characteristic physical findings that reflect significant dehydration and metabolic derangement. 1
Expected Vital Sign Abnormalities
Cardiovascular Instability
- Tachycardia is a hallmark finding in both diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), resulting from severe volume depletion and compensatory mechanisms 1
- Hypotension commonly occurs as intravascular volume contracts from osmotic diuresis and dehydration 1
- Shock may develop in severe cases, representing profound hemodynamic compromise requiring immediate aggressive fluid resuscitation 1
Respiratory Changes
- Kussmaul respirations (deep, labored breathing) are characteristic of DKA as the body attempts to compensate for metabolic acidosis through respiratory alkalosis 1
- This respiratory pattern is specific to DKA and typically absent in pure HHS 1
Temperature Abnormalities
- Patients can be normothermic or even hypothermic despite infection being the most common precipitating factor, due to peripheral vasodilation 1
- Hypothermia, when present, is a poor prognostic sign associated with increased mortality 1
Clinical Context and Severity
Progression Patterns
- HHS evolves over several days to weeks, allowing more gradual vital sign deterioration 1
- DKA can develop within 24 hours, with more acute vital sign instability 1
Hemodynamic Monitoring Priority
- Initial fluid therapy must be directed at restoring intravascular volume with isotonic saline at 15-20 ml/kg/h during the first hour (1-1.5 liters in average adults) 1
- Successful progress is judged by hemodynamic monitoring, specifically improvement in blood pressure, which confirms the baseline instability 1
Critical Pitfalls
Temperature Misinterpretation
- Do not rule out infection based on normal or low temperature alone - patients with hyperglycemic crisis and serious infections may be normothermic or hypothermic 1
- Obtain appropriate cultures and consider empiric antibiotics when infection is suspected, regardless of temperature 1
Prognosis Indicators
- The presence of hypotension substantially worsens prognosis at any age 1
- Coma combined with hypotension carries particularly high mortality risk 1
The fundamental pathophysiology—severe dehydration from osmotic diuresis, metabolic acidosis (in DKA), and extreme hyperosmolarity (in HHS)—makes vital sign instability an expected and defining feature rather than an exception. 1