• Diabetic Ketoacidosis (DKA)
• Hyperosmolar NonKetotic Coma (HNC)
• Serum of Inappropriate ADH (SIADH)
• Diabetes Insipidis (DI)

History:
Diabetes Mellitus, Diabetes Insipidus in past?

• Fatigue
• Blurry vision
• Abdominal Pain

Ins/Outs:

• Polyuria
• Polydipsia
• Polyphagia
• Polyuria
• Weight Loss

Physical:

• Low Blood Pressure:
  Due to volume loss in DKA/HNC
• Breath - odor of sweet, apples smell of acetone.
• Mental Stutus: Can be first sign of metabolic disorder.
  Delerium from exogenous steriods
  Hypersmolar coam

Labs:

• Glucose
• Na+/K+
• Serum osmolarity­>350 mOsm/L indicates cause for HNC
• DKA:
  • Glucose
  • pH <7.35
  • Bicarbonate < 15 mEq/L
  • Presence of ketones