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World J Clin Cases. Nov 16, 2022; 10(32): 11702-11711
Published online Nov 16, 2022. doi: 10.12998/wjcc.v10.i32.11702
Overlap of diabetic ketoacidosis and hyperosmolar hyperglycemic state
Esraa Mamdouh Hassan, Hisham Mushtaq, Esraa Elaraby Mahmoud, Sherley Chhibber, Shoaib Saleem, Ahmed Issa, Jain Nitesh, Abbas B Jama, Anwar Khedr, Sydney Boike, Mikael Mir, Noura Attallah, Salim Surani, Syed A Khan
Esraa Mamdouh Hassan, Jain Nitesh, Abbas B Jama, Noura Attallah, Syed A Khan, Critical Care Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
Hisham Mushtaq, Medicine, St. Vincent's Medical Center, Bridgeport, CT 06606, United States
Esraa Elaraby Mahmoud, Medicine, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
Sherley Chhibber, Medicine, Mercy Catholic Medical Center, Darby, PA 19025, United States
Shoaib Saleem, Medicine, Mayo Hospital, Lahore 54000, Punjab, Pakistan
Ahmed Issa, Medicine, Medical University of the Americas, Nevis, West Indies
Anwar Khedr, Medicine, BronxCare Health System, Bronx, NY 10457, United States
Sydney Boike, Mikael Mir, Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, United States
Salim Surani, Medicine & Pharmacology, Texas A&M University Health Science Center, College Station, TX 77843, United States
Salim Surani, Anesthesiolgy, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Hassan EM: Conceptualization, drafting, reviewing, final editing, and agreeing to the accuracy of the work; Mushtaq H: Conceptualization, drafting, reviewing, final editing, and agreeing to the accuracy of the work; Mahmoud EE: Conceptualization, drafting, reviewing, and agreeing to the accuracy of the work; Chhibber S: Drafting, editing, and agreeing to the final accuracy of the work; Saleem S: Drafting, editing, and agreeing to the final accuracy of the work; Issa A: Drafting, editing, and agreeing to the final accuracy of the work; Jama A: Drafting, editing, and agreeing to the final accuracy of the work; Khedr A: Literature search and review of the manuscript; Boike S: Editing and agreeing to the final accuracy of the work; Mir M: Editing and agreeing to the final accuracy of the work; Surani S: Supervision, critical revision of the manuscript, editing, reviewing, and agreeing to the final accuracy of the work; Khan SA: Supervision, critical revision of the manuscript, editing, reviewing, and agreeing to the final accuracy of the work.
Conflict-of-interest statement: There are no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salim Surani, FCCP, MD, MS, Professor, Medicine & Pharmacology, Texas A&M University Health Science Center, Administration Building, 400 Bizzell St, College Station, TX 77843, United States. srsurani@hotmail.com
Received: July 28, 2022
Peer-review started: July 28, 2022
First decision: September 4, 2022
Revised: September 14, 2022
Accepted: September 27, 2022
Article in press: September 27, 2022
Published online: November 16, 2022
Abstract

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemia state (HHS) are two life-threatening metabolic complications of diabetes that significantly increase mortality and morbidity. Despite major advances, reaching a uniform consensus regarding the diagnostic criteria and treatment of both conditions has been challenging. A significant overlap between these two extremes of the hyperglycemic crisis spectrum poses an additional hurdle. It has well been noted that a complete biochemical and clinical patient evaluation with timely diagnosis and treatment is vital for symptom resolution. Worldwide, there is a lack of large-scale studies that help define how hyperglycemic crises should be managed. This article will provide a comprehensive review of the pathophysiology, diagnosis, and management of DKA-HHS overlap.

Keywords: Diabetic ketoacidosis, Hyperosmolar Coma, Diabetes, Metabolic acidosis, Hypernatremia, Hyperosmolar hyperglycemia state

Core Tip: Diabetes ketoacidosis and hyperosmolar hyperglycemic coma are critical illnesses and medical emergencies associated with diabetes. Diabetic ketoacidosis (DKA) is associated with hyperglycemia and ketoacidosis, whereas hyperosmolar hyperglycemia state (HHS) mainly has severe hyperglycemia and hyperosmolarity. Up to 30% of patients with DKA may also have some features of HHS. Early diagnosis with aggressive management of hyperosmolarity, ketosis, and hyperglycemia can help prevent mortality.