ReviewInternational journal of emergency medicine2025
A narrative review of the diabetic ketoacidosis and hyperosmolar hyperglycemic state overlap syndrome.
Review in International journal of emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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Who cites it
4 citing papers in PubMed.
- Severe Hyperglycemic Crisis: A Presentation of Diabetic Ketoacidosis Requiring Intubation.Cureus · 2026Article
- Mechanistic insights into the role of salicin in mitigating oxidative and inflammatory pathways of diabetic complications.Molecular biology reports · 2026Review
- Periapical abscess precipitating diabetic ketoacidosis and reversible sepsis-induced cardiomyopathy: a case report.Frontiers in endocrinology · 2026Article
- Mapping the storm: a scoping review of diabetic emergencies in Africa.Frontiers in clinical diabetes and healthcare · 2026Review
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDiabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening acute complications of diabetes. Up to one-third of patients present with overlapping features of both syndromes, complicating diagnosis and management. This overlap is associated with higher mortality than isolated DKA or HHS.
objectiveThis narrative review synthesizes current evidence on the epidemiology, pathophysiology, and management of DKA-HHS overlap in both adult and pediatric populations with either type 1 or type 2 diabetes, highlighting the distinct challenges in recognition, treatment, and outcomes across these groups.
findingsWhile DKA is defined by ketosis and metabolic acidosis, and HHS by profound hyperglycemia and hyperosmolality, overlap presentations combine both abnormalities. These patients face increased risks of cerebral edema, thromboembolism, and acute kidney injury. Standardized management protocols remain lacking, and treatment must balance fluid resuscitation, insulin therapy, and electrolyte correction, with distinct approaches for adults and children. Emerging issues such as SGLT2 inhibitor-induced euglycemic DKA and disparities in outcomes between high- and low-resource settings further complicate care.
conclusionDKA-HHS overlap represents a high-risk clinical phenotype requiring early recognition and individualized therapy. Consensus guidelines, risk stratification tools, and studies of fluid and insulin strategies are urgently needed to improve outcomes in this vulnerable population.
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Registered trials
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