Management of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) in the emergency department

DKA and HHS are serious conditions that regularly present and require treatment in the Emergency Department. This flow chart aims to provide NSW emergency clinicians with a standardised approach to managing DKA and HHS, particularly in situations with no access to endocrinology support and advice.

There is considerable overlap in making the diagnosis and the treatment for each of these conditions. The more recent introduction of SGLT2 inhibitors for the management of long-term diabetes has meant a further refinement of diagnosis and treatment.

This flowchart is not intended to provide detailed management of these conditions. It provides a guide to the initial management relevant to Emergency Departments.

Usually, presentations of both conditions result in admission to either the intensive care unit or ward. However, the initial treatment can determine the success and duration of the inpatient stay. In many cases, this treatment needs to be initiated without the benefit of specialised endocrinology advice or guidance.