Key Learning Points

1. 1. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) have a high mortality rate and require prompt identification and management.

2. 2. Fluid resuscitation is often the most important therapeutic intervention in both groups, and patients with HHS often need no exogenous insulin at all.

3. 3. The high mortality rate often results from electrolyte disturbances, particularly hypokalaemia in DKA. It should be very closely monitored, particularly in the early phase of treatment.

4. 4. Thromboembolism is a life-threatening complication in both groups of patients, so always consider thromboprophylaxis early.

5. 5. Look for common precipitating factors in all patients, but be aware that the white cell count and amylase, sodium and creatinine levels can all be abnormal in otherwise uncomplicated diabetic emergencies.

Hyperosmolar hyperglycaemic state (HHS), usually seen in uncontrolled type 2 diabetics, is a life-threatening emergency with a mortality rate 10 times higher than that of DKA. This chapter provides key prescribing information on combating its primary features – dehydration, hyperglycaemia and increased thromboembolic risk.