Diabetologische Notfälle: hyperglykämische Krisen

Diabetic ketoacidosis (DKA) and the hyperglycaemic hyperosmolar state (HHS) are the two most serious, acute and life-threatening hyperglycaemic emergencies in people with type 1 diabetes and type 2 diabetes. In the last decade, global reports show an increase in the number of DKA and HHS hospital admissions. A diagnosis of DKA is confirmed when all three of the criteria are present: “D”, either elevated blood glucose levels or a history of diabetes mellitus; “K”, the presence of high urinary or blood ketoacids; and “A”, a high anion gap metabolic acidosis. HHS is characterized by severe hyperglycaemia, marked hyperosmolality, and dehydration in the absence of significant ketosis or acidosis. Early diagnosis and management are important to improve patient outcomes. The treatment includes restoration of circulating volume, insulin therapy, electrolyte replacement, and treatment of any underlying precipitating event. Without optimal treatment, DKA remains a condition with appreciable, although largely preventable, morbidity and mortality. The implementation of DKA/HHS protocols in hospitals is recommended. Repeated training of patients and health care professionals, including on sick day rules, is crucial in the prevention and treatment of hyperglycaemic crises.