{"id":7997,"date":"2020-10-15T21:33:05","date_gmt":"2020-10-15T21:33:05","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/?p=8042"},"modified":"2026-01-07T19:50:21","modified_gmt":"2026-01-07T19:50:21","slug":"diabetic-ketoacidosis-hyperosmolar","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/es\/diabetic-ketoacidosis-hyperosmolar\/","title":{"rendered":"Criterios Diagn\u00f3stico de Cetoacidosis Diab\u00e9tica y Estado Hipergluc\u00e9mico Hiperosmolar"},"content":{"rendered":"<div class=\"7ca9444b8380138fe077da07353677a4\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>Un diagn\u00f3stico de cetoacidosis diab\u00e9tica (CAD) requiere que la concentraci\u00f3n de glucosa plasm\u00e1tica del paciente sea superior a 250 mg\/dl (aunque generalmente es mucho m\u00e1s alta), el nivel de pH sea inferior a 7,30 y el nivel de bicarbonato sea de 18 mEq\/L o menos.<!--more--><\/p>\n<p>El estado hipergluc\u00e9mico hiperosmolar (EHH) es la urgencia hipergluc\u00e9mica aguda m\u00e1s grave en pacientes con diabetes tipo 2, caracterizada por hiperglucemia severa y glucosuria en ausencia de respiraci\u00f3n de Kussmaul, con aliento con olor afrutado o prueba de acetona positiva en la orina. Los criterios diagn\u00f3sticos actuales de EHH incluyen un nivel de glucosa plasm\u00e1tica &gt; 600 mg\/dl y una osmolalidad plasm\u00e1tica efectiva aumentada &gt; 320 mOsm\/kg en ausencia de cetoacidosis.<\/p>\n<p><strong>Criterios Diagn\u00f3stico de Cetoacidosis Diab\u00e9tica y Estado Hipergluc\u00e9mico Hiperosmolar<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr style=\"height: 24px;\">\n<td style=\"width: 20%; height: 24px;\"><\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\"><strong>CAD Leve<\/strong><\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\"><strong>CAD Moderada<\/strong><\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\"><strong>CAD Severa<\/strong><\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\"><strong>EHH<\/strong><\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 20%; height: 24px;\">Glucosa plasm\u00e1tica (mg\/dL [mmol\/L])<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">&gt; 250 (13.9)<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">&gt; 250<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">&gt; 250<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">600 (33.3)<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 20%; height: 24px;\">pH Arterial<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">7.25 a 7.30<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">7.00 a 7.24<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">&lt; 7.00<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">&gt; 7.30<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 20%; height: 24px;\">Bicarbonato s\u00e9rico (mEq\/L)<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">15 a 18<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">10 a &lt; 15<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">&lt; 10<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">&gt; 15<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 20%; height: 24px;\">Cetonas en orina<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Positivo<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Positivo<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Positivo<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Escasas<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 20%; height: 24px;\">Cetonas s\u00e9ricas<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Positivo<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Positivo<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Positivo<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Escasas<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 20%; height: 24px;\">Beta-hidroxibutirato<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Elevado<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Elevado<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Elevado<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Normal o elevado<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 20%; height: 24px;\">Osmolalidad efectiva s\u00e9rica (mOsm\/kg)*<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Variable<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Variable<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Variable<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">&gt; 320<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 20%; height: 24px;\">Ani\u00f3n gap\u2020<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">&gt; 10<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">&gt; 12<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">&gt; 12<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Variable<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 20%; height: 24px;\">Alteraci\u00f3n del sensorio u obnubilaci\u00f3n mental<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Alerta<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Alerta\/somnolencia<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Estupor\/coma<\/td>\n<td style=\"width: 20%; height: 24px; text-align: center;\">Estupor\/coma<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>*Osmolalidad efectiva s\u00e9rica = 2 \u00d7 Na medido (mEq\/L) + (glucosa [mg\/dL] \u00f7 18).<br \/>\n\u2020Ani\u00f3n gap = Na+ \u2013 (Cl\u2013 + HCO3\u2013 [mEq\/L]).<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Bibliograf\u00eda:<\/strong><\/p>\n<ol>\n<li>Karslioglu French E, Donihi AC, Korytkowski MT. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. BMJ. 2019 May 29;365:l1114. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31142480\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Pasquel FJ, Umpierrez GE. Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment. Diabetes Care. 2014 Nov;37(11):3124-31. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/25342831\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Fayfman M, Pasquel FJ, Umpierrez GE. Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. Med Clin North Am. 2017 May;101(3):587-606. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28372715\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Trachtenbarg DE. Diabetic ketoacidosis. Am Fam Physician. 2005 May 1;71(9):1705-14. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/15887449\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Abady E, Tamvakologos PI, Mourid MR, Abdelrahman ST, Aziz MM, Rath S, Carr LA, Alsabri M. A narrative review of the diabetic ketoacidosis and hyperosmolar hyperglycemic state overlap syndrome. Int J Emerg Med. 2025 Nov 21;18(1):244. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/41272457\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Creado Oct 15, 2020.<br \/>\nActualizado Ene 07, 2026.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Un diagn\u00f3stico de cetoacidosis diab\u00e9tica (CAD) requiere que la concentraci\u00f3n de glucosa plasm\u00e1tica del paciente sea superior a 250 mg\/dl (aunque generalmente es mucho m\u00e1s alta), el nivel de pH sea inferior a 7,30 y el nivel de bicarbonato sea de 18 mEq\/L o menos.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[626],"tags":[2251,16,15,1120,1119,14,13,2253,543,2252,2250,2257,2254,2255,2256,881],"class_list":["post-7997","post","type-post","status-publish","format-standard","hentry","category-diabetes","tag-cetoacidosis","tag-criteria","tag-criterios","tag-diabetic","tag-diabetica","tag-diagnostic","tag-diagnostico","tag-dka","tag-estado","tag-hhs","tag-hiperglucemico","tag-hiperosmolar","tag-hyperglycemic","tag-hyperosmolar","tag-ketoacidosis","tag-state"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/posts\/7997","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/comments?post=7997"}],"version-history":[{"count":3,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/posts\/7997\/revisions"}],"predecessor-version":[{"id":10570,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/posts\/7997\/revisions\/10570"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/media?parent=7997"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/categories?post=7997"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/tags?post=7997"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}