Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

Med Clin North Am. 2017 May;101(3):587-606. doi: 10.1016/j.mcna.2016.12.011.


Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are the most serious and life-threatening hyperglycemic emergencies in diabetes. DKA is more common in young people with type 1 diabetes and HHS in adult and elderly patients with type 2 diabetes. Features of the 2 disorders with ketoacidosis and hyperosmolality may coexist. Both are characterized by insulinopenia and severe hyperglycemia. Early diagnosis and management are paramount. Treatment is aggressive rehydration, insulin therapy, electrolyte replacement, and treatment of underlying precipitating events. This article reviews the epidemiology, pathogenesis, diagnosis, and management of hyperglycemic emergencies.

Keywords: Diabetes; Diabetic ketoacidosis; Hyperglycemic emergencies; Hyperglycemic hyperosmolar state; Management of hyperglycemic emergencies.

Publication types

  • Review

MeSH terms

  • Bicarbonates / therapeutic use
  • Diabetes Complications / diagnosis
  • Diabetes Complications / physiopathology
  • Diabetic Ketoacidosis / diagnosis*
  • Diabetic Ketoacidosis / epidemiology
  • Diabetic Ketoacidosis / physiopathology*
  • Diabetic Ketoacidosis / therapy
  • Emergencies*
  • Fluid Therapy
  • Hospital Mortality
  • Humans
  • Hyperglycemic Hyperosmolar Nonketotic Coma / diagnosis*
  • Hyperglycemic Hyperosmolar Nonketotic Coma / epidemiology
  • Hyperglycemic Hyperosmolar Nonketotic Coma / physiopathology*
  • Hyperglycemic Hyperosmolar Nonketotic Coma / therapy
  • Hypoglycemic Agents / therapeutic use
  • Inflammation / physiopathology
  • Insulin / therapeutic use
  • Oxidative Stress / physiology
  • Sodium-Glucose Transporter 2 Inhibitors


  • Bicarbonates
  • Hypoglycemic Agents
  • Insulin
  • Sodium-Glucose Transporter 2 Inhibitors