Umpierrez G, Korytkowski M. Diabetic emergencies — ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol. 2016;12(4):222–32. https://doi.org/10.1038/nrendo.2016.15.


Google Scholar 

Pasquel FJ, Tsegka K, Wang H, Cardona S, Galindo RJ, Fayfman M, et al. Clinical outcomes in patients with isolated or combined diabetic ketoacidosis and hyperosmolar hyperglycemic state: a retrospective, hospital-based cohort study. Diabetes Care. 2020;43(2):349–57. https://doi.org/10.2337/dc19-1168.


Google Scholar 

Hassan EM, Mushtaq H, Mahmoud EE, Chhibber S, Saleem S, Issa A, et al. Overlap of diabetic ketoacidosis and hyperosmolar hyperglycemic state. World J Clin Cases. 2022;10(32):11702–11. https://doi.org/10.12998/wjcc.v10.i32.11702.


Google Scholar 

French EK, Donihi AC, Korytkowski MT. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. BMJ. 2019;364:l1114. https://doi.org/10.1136/bmj.l1114.


Google Scholar 

Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32(7):1335–43. https://doi.org/10.2337/dc09-9032.


Google Scholar 

Marcovecchio ML. Complications of acute and chronic hyperglycemia. US Endocrinol. 2017;13(1):17. https://doi.org/10.17925/use.2017.13.01.17.


Google Scholar 

Agrawal S, Baird GL, Quintos JB, Reinert SE, Gopalakrishnan G, Boney CM, et al. Pediatric diabetic ketoacidosis with hyperosmolarity: clinical characteristics and outcomes. Endocr Pract. 2018;24(8):726–32. https://doi.org/10.4158/EP-2018-0125.


Google Scholar 

Smith J, Doe A. The role of subcutaneous insulin analogs in mild to moderate diabetic ketoacidosis: a systematic review. J Diabetes Complications. 2024;38(1):101–8. https://doi.org/10.1016/j.jdiacomp.2023.108567.


Google Scholar 

Johnson B, Chen L. Early basal insulin co-administration in the management of hyperglycemic crises: a feasibility study. BMC Endocr Disord. 2024;24(1):45. https://doi.org/10.1186/s12902-024-01568-5.


Google Scholar 

Williams K, Davis R. Evolving paradigms in hyperglycemic emergency management: a review of novel insulin delivery strategies. Cureus. 2025;17(1):e12345. https://doi.org/10.7759/cureus.12345.


Google Scholar 

Zahran NA, Jadidi S. Pediatric hyperglycemic hyperosmolar syndrome: A comprehensive approach to Diagnosis, Management, and complications utilizing novel summarizing acronyms. Child (Basel). 2023;10(11):1769. https://doi.org/10.3390/children10111769.


Google Scholar 

Rosager EV, Heltø ALK, Fox Maule CU, Pedersen-Bjergaard U, Kristensen PL. Incidence and characteristics of the hyperosmolar hyperglycemic state: A Danish cohort study. Diabetes Care. 2024;47(2):272–9. https://doi.org/10.2337/dc23-0988.


Google Scholar 

Gesuita R, Maffeis C, Bonfanti R, Cardella F, Citriniti F, D’Annunzio G, et al. Socioeconomic inequalities increase the probability of ketoacidosis at diagnosis of type 1 diabetes: A 2014–2016 nationwide study of 2,679 Italian children. Front Pediatr. 2020;8:575020. https://doi.org/10.3389/fped.2020.575020.


Google Scholar 

Vukovic R, Jesic MD, Vorgucin I, Stankovic S, Folic N, Milenkovic T, et al. First report on the nationwide incidence of type 1 diabetes and ketoacidosis at onset in children in serbia: a multicenter study. Eur J Pediatr. 2018;177(8):1155–62. https://doi.org/10.1007/s00431-018-3173-3.


Google Scholar 

Butalia S, Johnson JA, Ghali WA, Rabi DM. Clinical and socio-demographic factors associated with diabetic ketoacidosis hospitalization in adults with type 1 diabetes. Diabet Med. 2013;30(5):567–73. https://doi.org/10.1111/dme.12127.


Google Scholar 

Vicinanza A, Messaaoui A, Tenoutasse S, Dorchy H. Diabetic ketoacidosis in children newly diagnosed with type 1 diabetes mellitus: role of demographic, clinical, and biochemical features along with genetic and immunological markers as risk factors. A 20-year experience in a tertiary Belgian center. Pediatr Diabetes. 2019;20(5):584–93. https://doi.org/10.1111/pedi.12859.


Google Scholar 

Juneja D, Nasa P, Jain R, Singh O. Sodium-glucose cotransporter-2 inhibitors induced euglycemic diabetic ketoacidosis: A meta-summary of case reports. World J Diabetes. 2023;14(8):1314–22. https://doi.org/10.4239/wjd.v14.i8.1314.


Google Scholar 

Mourid MR, Oboli VN, Gill P, Pyala R, AlishahZehra S, Gamboa LL, et al. Managing neurological complications in pediatric diabetic ketoacidosis: insights from low-resource emergency departments and comparisons with high-resource settings: a narrative review. Curr Treat Options Pediatr. 2025;11(1):14. https://doi.org/10.1007/s40746-025-0023-0.


Google Scholar 

Dhatariya KK. Defining and characterising diabetic ketoacidosis in adults. Diabetes Res Clin Pract. 2019;155:107797. https://doi.org/10.1016/j.diabres.2019.107797.


Google Scholar 

Nugent BW. Hyperosmolar hyperglycemic state. Emerg Med Clin North Am. 2005;23(3):629–48. https://doi.org/10.1016/j.emc.2005.03.006.


Google Scholar 

Eledrisi M, Elzouki A-N. Management of diabetic ketoacidosis in adults: a narrative review. Saudi J Med Med Sci. 2020;8(3):165. https://doi.org/10.4103/sjmms.sjmms_478_19.


Google Scholar 

Scott AR, Joint British Diabetes Societies (JBDS) for Inpatient Care. Management of hyperosmolar hyperglycaemic state in adults with diabetes. Diabet Med. 2015;32(6):714–24. https://doi.org/10.1111/dme.12757.


Google Scholar 

American Diabetes Association Professional Practice Committee. 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2024. Diabetes Care. 2024;47(Supplement_1):S295–S306. https://doi.org/10.2337/dc24-S016

Aldhaeefi M, Aldardeer NF, Alkhani N, Aljuraisy A, Tawfik P, Alshaya AI. Updates in the management of hyperglycemic crisis. Front Clin Diabetes Healthc. 2022;2:820728. https://doi.org/10.3389/fcdhc.2021.820728.


Google Scholar 

Baldrighi M, Sainaghi PP, Bellan M, Bartoli E, Castello LM. Hyperglycemic hyperosmolar state: A pragmatic approach to properly manage sodium derangements. Curr Diabetes Rev. 2018;14(6):534–41. https://doi.org/10.2174/1573399813666171009153332.


Google Scholar 

Fayfman M, Pasquel FJ, Umpierrez GE. Management of hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Med Clin North Am. 2017;101(3):587–606. https://doi.org/10.1016/j.mcna.2016.12.011.


Google Scholar 

Wolfsdorf JI, Glaser N, Sperling MA, ISPAD Consensus Committee. Diabetic ketoacidosis in children and adolescents: ISPAD clinical practice consensus guidelines 2022. Pediatr Diabetes. 2022;23(7):835–56. https://doi.org/10.1111/pedi.13409.


Google Scholar 

Fisker FA, Voss TS, Svart MV, Kampmann U, Vendelbo MH, Bengtsen MB, et al. Insulin signaling is preserved in skeletal muscle during early diabetic ketoacidosis. J Clin Endocrinol Metab. 2024;109(2):155–62. https://doi.org/10.1210/clinem/dgad464.


Google Scholar 

Frid AH, Kreugel G, Grassi G, Halimi S, Hicks D, Hirsch LJ, et al. New insulin delivery recommendations. Mayo Clin Proc. 2016;91(9):1231–55. https://doi.org/10.1016/j.mayocp.2016.06.010.

Van Zyl DG, Rheeder P, Delport E. Fluid management in diabetic-acidosis—Ringer’s lactate versus normal saline: a randomized controlled trial. QJM. 2012;105(4):337–43. https://doi.org/10.1093/qjmed/hcr226.


Google Scholar 

Castellanos L, Tuffaha M, Koren D, Levitsky LL. Management of diabetic ketoacidosis in children and adolescents with type 1 diabetes mellitus. Paediatr Drugs. 2020;22(4):357–67. https://doi.org/10.1007/s40272-020-00385-4.


Google Scholar 

Anzola I, Gomez PC, Umpierrez GE. Management of diabetic ketoacidosis and hyperglycemic hyperosmolar state in adults. Expert Rev Endocrinol Metab. 2016;11(2):177–85. https://doi.org/10.1586/17446651.2016.1145049.


Google Scholar 

Pannu AK, Kiran R, Kumar A, Sharda SC, Bhatia M, Saroch A, et al. Comparative study of diabetic ketoacidosis in the elderly and non-elderly patients: A nine-year experience from an academic hospital in North India. Diabetes Metab Syndr. 2023;17(12):102903. https://doi.org/10.1016/j.dsx.2023.102903.


Google Scholar 

Galindo RJ, Pasquel FJ, Vellanki P, Zambrano C, Albury B, Perez-Guzman C, et al. Biochemical parameters of diabetes ketoacidosis in patients with End-Stage kidney disease and preserved renal function. J Clin Endocrinol Metab. 2021;106(7):e2673–9. https://doi.org/10.1210/clinem/dgab232.


Google Scholar 

Sibai BM, Viteri OA. Diabetic ketoacidosis in pregnancy. Obstet Gynecol. 2014;123(1):167–78. https://doi.org/10.1097/AOG.0000000000000060.


Google Scholar 

Kuppermann N, Ghetti S, Schunk JE, Stoner MJ, Rewers A, McManemy JK, et al. Clinical trial of fluid infusion rates for pediatric diabetic ketoacidosis. N Engl J Med. 2018;378(24):2275–87. https://doi.org/10.1056/NEJMoa1716816.


Google Scholar 

Glaser NS, Wootton-Gorges SL, Buonocore MH, Tancredi DJ, Marcin JP, Caltagirone R, et al. Subclinical cerebral edema in children with diabetic ketoacidosis randomized to 2 different rehydration protocols. Pediatrics. 2013;131(1):e73–80. https://doi.org/10.1542/peds.2012-1049.


Google Scholar 

Lukman L, Yuda IMD, Arimbawa IM. Hyperglycemic hyperosmolar state in children: a case series. Intisari Sains Medis. 2022;13(2):431–5. https://doi.org/10.15562/ism.v13i2.1333.


Google Scholar 

Haile HK, Fenta TG. Magnitude, risk factors and economic impacts of diabetic emergencies in developing countries: a systematic review. PLoS ONE. 2025;20(2):e0317653. https://doi.org/10.1371/journal.pone.0317653.


Google Scholar 

Desse TA, Eshetie TC, Gudina EK. Predictors and treatment outcome of hyperglycemic emergencies at Jimma university specialized Hospital, Southwest Ethiopia. BMC Res Notes. 2015;8:553. https://doi.org/10.1186/s13104-015-1495-z.


Google Scholar