Hyperglycemia is a common finding encountered in the emergency department and on the hospital floor. The two main conditions associated with hyperglycemia are diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Aside from treating the symptoms of these conditions and lowering the glucose, it is important to determine the etiology so that the underlying problem may be addressed.
An article published in Clinical Diabetes in March 2011 defined their “Five I’s” for the main causes of hyperglycemia. I won’t list them all here because I think that their list can be improved. I modified and added to their list (along with consulting my ER preceptor and UpToDate) to come up with “Eight I’s” for the causes of hyperglycemia.
The “Eight I’s” mnemonic for the main causes of hyperglycemia is:
- Infection (think pancreatitis, pneumonia, and UTI)
- Infarction (think MI)
- Infraction (think patient noncompliant with therapy)
- Infant (think pregnancy)
- Ischemic (think CVA)
- Illegal (think cocaine abuse)
- Iatrogenic (think prescription drug interactions, e.g. steroids)
- Idiopathic (think new onset type 1 diabetes or other cause)
Now you can remember the “Eight I’s” that cause HyperglYcemia!
The next time you are confronted with a patient with very high glucose, use this list to quickly go over the main causes. If one of them fits, you can start the additional workup to help the patient as best as possible!
Kitabchi, AE, and BD Rose. Clinical features and diagnosis of diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011.
McNaughton, Candace D., Wesley H. Self, and Corey Slovis. “Diabetes in the Emergency Department: Acute Care of Diabetes Patients.” Clinical Diabetes 29.2 (2011): 51-59. DiabetesJournals.org. American Diabetes Association. Web. 20 Dec. 2011. <http://clinical.diabetesjournals.org/content/29/2/51.full>