Journal article
A narrative review of the diabetic ketoacidosis and hyperosmolar hyperglycemic state overlap syndrome
International journal of emergency medicine, v 18(1), 244
21 Nov 2025
PMID: 41272457
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background: Diabetic 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.
Metrics
1 Record Views
Details
- Title
- A narrative review of the diabetic ketoacidosis and hyperosmolar hyperglycemic state overlap syndrome
- Creators
- Eslam Abady - Tanta UniversityPanos I. Tamvakologos - St. George's UniversityMarina Ramzy Mourid - Alexandria UniversitySalma Tamer Abdelrahman - Zagazig UniversityMayam Mohamed Aziz - Menoufia UniversityShree Rath - All India Institute of Medical Sciences BhubaneswarLauren A. Carr - St. Christopher's Hospital for ChildrenMohammed Alsabri (Corresponding Author) - Drexel University, College of Medicine
- Publication Details
- International journal of emergency medicine, v 18(1), 244
- Publisher
- Springer Nature
- Number of pages
- 9
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics; College of Medicine
- Web of Science ID
- WOS:001628479400001
- Scopus ID
- 2-s2.0-105022603042
- Other Identifier
- 991022197326104721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
Source: SDGs in the Output
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Emergency Medicine