Hyperglycemic Crises

Hyperglycemic emergencies, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), are life-threatening complications requiring urgent treatment. DKA is more common in type 1 diabetes and results from absolute insulin deficiency, leading to hyperglycemia, dehydration, ketonemia and metabolic acidosis. Symptoms include polyuria, polydipsia, nausea, vomiting, and altered mental status. HHS is typically seen in type 2 diabetes and is defined by extreme hyperglycemia, severe dehydration, and hyperosmolarity without significant ketoacidosis. It often presents with confusion and neurological symptoms. Diagnosis of these conditions relies on blood glucose and ketone levels, blood gas, and electrolyte measurements. Fluid resuscitation, insulin therapy, and electrolyte correction are the mainstays of treatment. In HHS, intravenous insulin is used more cautiously to prevent rapid osmolar shifts and cerebral edema. Treatment protocols slightly differ in pregnancy, euglycemic ketoacidosis, and advanced kidney disease. Preventative strategies include education on sick day rules, regular clinic follow-ups in high-risk groups, and adherence to insulin therapy. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.