Diabetic ketoacidosis (DKA) and hy perosmolar hyperglycemic state (HHS) are two important causes of mortality and morbidity in patients with diabetes. Mortality rates are <5% in DKA and about 15% in HHS, much of which are avoidable with appropriate management. The prognosis is worsened with aging, hypotension, coma and concomitant life-threatening illnesses. The criteria for DKA and HHS are somewhat arbitrary, although glucose level is higher and ketone body level is minimal in HHS, they are two extremes in a spectrum of diabetic metabolic decompensation. In general, DKA occurs in type 1 and most often HHS occurs in type 2 diabetes; however, each type of diabetes may be associated with DKA or HHS. Both conditions are associated with marked dehydration, electrolyte disturbances and insulin deficiency and increased counter-regulatory hormones, so treatment consists of water and electrolyte replacement and insulin administration. Recognition and treatment of precipitating factors and frequent monitoring of patients are considered the most crucial aspects of the management.
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