Diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS) and mixed presentations are endocrine emergencies, requiring urgent management with intravenous fluids and insulin, correction of electrolyte abnormalities, and assessment and treatment of precipitating factors.
DKA, HHS and mixed presentations accounted for 36% of the total endocrine admissions to a tertiary centre between May 2022 and April 2024, with DKA representing 50% (n=43). A further 19% (n=16) were for HHS, with 31% (n=27) being mixed. The patients were majority male (55%) and had type 1 diabetes (T1DM) (51%). Patients with T1DM were younger (39.6 vs 62 years), less overweight (BMI 24.4 vs 28.9) and had better glycaemic control (HbA1c 11.6% vs 12.3%) than patients with T2DM. Only 10% of patients had a new diagnosis of diabetes, yet only 57% of patients were known to a specialist or hospital service. The most common precipitant of DKA was medication non-compliance (n=17), but for HHS and mixed presentations, infection was most prevalent (n=6, n=12). Pump failure precipitated a total of 4 admissions.
All patients were managed with an insulin infusion. A total of 33 patients required ICU admission. HHS presentations were most likely to require ICU and had the longest length of stay. There were no mortalities within 30 days of admission.
DKA, HHS and mixed presentations contribute significantly to endocrine admissions. Around half are known to an endocrinology service, despite the vast majority having a known diagnosis. With education regarding medication non-compliance and sick-day management, a substantial proportion of these presentations could be prevented.