Current Concepts in Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

Abstract

Introduction: Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS) represent the most common acute hyperglycemic emergencies in diabetes mellitus (DM). This review synthesizes current evidence on the epidemiology, pathophysiology, diagnosis, and management of these critical conditions. Methods: We conducted a literature review utilizing PubMed, Embase, and Google Scholar, using the search terms “Hyperglycemic crises,” “Diabetic ketoacidosis,” and “Hyperosmolar hyperglycemic state” combined with “Epidemiology,” “Physiopathology,” “Clinical presentation,” and “Treatment.” Twenty-three articles were selected for full-text analysis. The AI tools GPT-5 (OpenAI, 2025) and Microsoft Copilot 365 (Microsoft, 2025) were used for methodological optimization and manuscript refinement. All co-authors performed a final review and approved the manuscript. Conclusions: DKA and HHS are life-threatening complications of DM. DKA is defined by ketosis and metabolic acidosis, whereas HHS is characterized by severe hyperosmolarity and dehydration, with minimal or absent acidosis. Key precipitants for both include infections and non-adherence to treatment. Diagnosis relies on specific clinical and laboratory criteria. Management is centered on intravenous rehydration, electrolyte replacement, insulin therapy, and continuous monitoring.