Obesity Class and Severity of Metabolic Emergencies: A Single-Center Retrospective Five-Year Study.

: This study aims to investigate the impact of obesity severity on the prevalence and outcomes of acute metabolic emergencies in the emergency department (ED) setting, with a specific focus on obesity class stratification and associated metabolic complications. : This retrospective, single-center study analyzed data from 433 patients admitted to the ED of the Timisoara Municipal Emergency Hospital between January 2019 and March 2024. Patients were classified according to WHO obesity grades (Class I: BMI 30.0-34.9 kg/m, Class II: 35.0-39.9 kg/m, Class III: ≥ 40.0 kg/m). The prevalence and severity of metabolic emergencies, including hyperglycemic crises, acute kidney injury (AKI), and severe electrolyte imbalances, were compared across obesity classes. : Obese patients (37.2%) exhibited a significantly higher prevalence of metabolic emergencies than non-obese individuals ( < 0.001). Hyperglycemia was present in 27.9% of obese patients vs. 11.0% of non-obese patients ( < 0.001). AKI incidence nearly doubled in obese patients (12.4% vs. 5.5%, = 0.01). Logistic regression identified Class III obesity as an independent risk factor for metabolic emergencies (adjusted OR = 3.2, 95% CI: 2.1-4.9, < 0.001). : The severity of metabolic emergencies increases with increasing obesity class, emphasizing the need for obesity-specific risk stratification in ED settings. Routine monitoring of metabolic markers and early intervention strategies should be prioritized for high-risk obese patients.