Coma diabeticum:: Current therapy of diabetic ketoacidosis and non-ketoacidotic hyperosmolar coma

This review summarizes the current therapeutic approach to diabetic ketoacidosis and hyperosmolar coma. The outline focuses on emergency treatment and management in the intensive care unit, particularly with regard to volume and insulin therapy and potassium replacement. The basic concepts of low and very low insulin therapy are presented, with special emphasis on the pathogenesis and avoidance of the disequilibrium syndrome. Furthermore, the indications for bicarbonate therapy as well as phosphate and magnesium replacement in diabetic ketoacidosis are critically discussed. This practically oriented review incorporates the current guidelines of the German diabetes association on this topic. With present-day treatment options, the therapeutic goal of a low mortality can be achieved.