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<p>Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) are acute metabolic emergencies that continue to be associated with relevant morbidity and mortality. While DKA occurs more frequently in people with type&#xa0;1 diabetes mellitus, HHS mainly affects older people with type&#xa0;2 diabetes mellitus. Mixed presentations are common and complicate clinical classification. The pathophysiology is based on absolute or relative insulin deficiency with consecutive hyperglycaemia, increased lipolysis and ketogenesis (DKA), osmotic diuresis, dehydration and electrolyte disturbances. Clinical manifestations include polyuria, polydipsia, dehydration, nausea, vomiting, abdominal complaints and neurological symptoms up to altered consciousness. Diagnosis is based on blood glucose, blood gas analysis, ketone measurement, electrolytes and serum osmolality. Treatment includes rapid volume replacement, insulin therapy, potassium supplementation and treatment of precipitating causes. Euglycaemic ketoacidosis associated with SGLT‑2 inhibitor use requires special attention. This article summarizes current guideline recommendations and discusses practice-oriented aspects for outpatient care.</p>

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Diabetische Ketoazidose (DKA) und hyperosmolares, hyperglykämisches Syndrom (HHS)

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月3日

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  • Miriam Meister,
  • Gerlies M. Treiber,
  • Harald Sourij

摘要

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) are acute metabolic emergencies that continue to be associated with relevant morbidity and mortality. While DKA occurs more frequently in people with type 1 diabetes mellitus, HHS mainly affects older people with type 2 diabetes mellitus. Mixed presentations are common and complicate clinical classification. The pathophysiology is based on absolute or relative insulin deficiency with consecutive hyperglycaemia, increased lipolysis and ketogenesis (DKA), osmotic diuresis, dehydration and electrolyte disturbances. Clinical manifestations include polyuria, polydipsia, dehydration, nausea, vomiting, abdominal complaints and neurological symptoms up to altered consciousness. Diagnosis is based on blood glucose, blood gas analysis, ketone measurement, electrolytes and serum osmolality. Treatment includes rapid volume replacement, insulin therapy, potassium supplementation and treatment of precipitating causes. Euglycaemic ketoacidosis associated with SGLT‑2 inhibitor use requires special attention. This article summarizes current guideline recommendations and discusses practice-oriented aspects for outpatient care.