Diabetic hyperglycemic emergencies: a systematic approach

Emerg Med Pract. 2020 Feb;22(2):1-20. Epub 2020 Feb 1.


For patients presenting with suspected diabetic ketoacidosis (DKA) and the hyperosmolar hyperglycemic state (HHS) understanding of the etiology and pathophysiology will ensure optimal emergency management. Morbidity and mortality is most often due to the underlying precipitating cause, which may include infection, infarction/ischemia, noncompliance with insulin therapy, pregnancy, and dietary indiscretion. Current guidelines are based primarily on expert opinion and consensus statements, but more recent evidence suggests that recommendations related to arterial blood gas, insulin bolus, and IV fluid replacement should be re-evaluated. This issue presents an approach to DKA and HHS management based on current evidence, with a simplified pathway for emergency department management.

MeSH terms

  • Diabetes Complications / drug therapy
  • Diabetes Complications / physiopathology
  • Diabetes Mellitus / drug therapy
  • Diabetic Ketoacidosis / drug therapy
  • Diabetic Ketoacidosis / physiopathology
  • Fluid Therapy / methods*
  • Humans
  • Hyperglycemia / drug therapy
  • Hyperglycemia / physiopathology*
  • Hyperglycemic Hyperosmolar Nonketotic Coma / drug therapy
  • Hyperglycemic Hyperosmolar Nonketotic Coma / physiopathology
  • Hypoglycemic Agents / therapeutic use
  • Insulin / therapeutic use


  • Hypoglycemic Agents
  • Insulin