Hyperglycemic crisis

J Emerg Med. 2013 Nov;45(5):797-805. doi: 10.1016/j.jemermed.2013.03.040. Epub 2013 Jun 18.


Background: Hyperglycemic crisis is a metabolic emergency associated with uncontrolled diabetes mellitus that may result in significant morbidity or death. Acute interventions are required to manage hypovolemia, acidemia, hyperglycemia, electrolyte abnormalities, and precipitating causes. Despite advances in the prevention and management of diabetes, its prevalence and associated health care costs continue to increase worldwide. Hyperglycemic crisis typically requires critical care management and hospitalization and contributes to global health expenditures.

Objective: Diagnostic and resolution criteria and management strategies for diabetic ketoacidosis and hyperosmolar hyperglycemic crisis are provided. A discussion of prevalence, mortality, pathophysiology, risk factors, clinical presentation, differential diagnosis, evaluation, and management considerations for hyperglycemic crisis are included.

Discussion: Emergency physicians confront the most severe sequelae of uncontrolled diabetes and provide crucial, life-saving management. With ongoing efforts from diabetes societies to incorporate the latest clinical research to refine treatment guidelines, management and outcomes of hyperglycemic crisis in the emergency department continue to improve.

Conclusion: We provide an overview of the evaluation and treatment of hyperglycemic crisis and offer a concise, targeted management algorithm to aid the practicing emergency physician.

Keywords: diabetes; diabetic ketoacidosis; hyperglycemic crisis; hyperglycemic emergency; hyperosmolar hyperglycemic state; metabolic acidosis.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Algorithms
  • Bicarbonates / therapeutic use
  • Blood Glucose / metabolism
  • Child
  • Child, Preschool
  • Diabetic Ketoacidosis / blood
  • Diabetic Ketoacidosis / diagnosis*
  • Diabetic Ketoacidosis / therapy*
  • Emergencies
  • Fluid Therapy
  • Humans
  • Hyperglycemia / blood
  • Hyperglycemia / diagnosis*
  • Hyperglycemia / therapy*
  • Hyperglycemic Hyperosmolar Nonketotic Coma / blood
  • Hyperglycemic Hyperosmolar Nonketotic Coma / diagnosis*
  • Hyperglycemic Hyperosmolar Nonketotic Coma / therapy*
  • Infant
  • Insulin / therapeutic use
  • Potassium / blood
  • Potassium / therapeutic use
  • Risk Factors


  • Bicarbonates
  • Blood Glucose
  • Insulin
  • Potassium