ABSTRACT
Hyperosmolar hyperglycaemic state (HSS) is characterised by evidence of hypovolaemia, hyperglycaemia without ketonaemia or acidosis. Diabetic ketoacidosis (DKA) is an abnormal metabolic state caused by a deficiency in insulin leading to a triad of clinical features: hyperglycaemia, ketonaemia, and acidosis. The increase in glucose production leads to severe hyperglycaemia and the breakdown of fatty acids as an alternative form of energy produces ketone bodies causing a metabolic acidosis. A detailed clinical history and performing a full systems examination is essential in finding the underlying cause of DKA. Administration of appropriate fluid to a patient suffering with DKA is the most important therapeutic intervention. Serum potassium levels in the body will fall as the insulin infusion is commenced. A rare complication usually associated with poor underlying cardiac function. Critical care input may be required where large volume fluid resuscitation may prove problematic to allow central venous monitoring and targeted fluid replacement.
