References
The role of ACPs in recognising and treating diabetic ketoacidosis and hyperosmolar hyperglycaemic state
Abstract
Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) are both diabetic emergencies that require immediate identification and intervention. Advanced clinical practitioners (ACPs) play a crucial role in the early detection, management and co-ordination of care for patients with these conditions, although some may feel less confident in handling such complex cases. This clinical review explores the role of ACPs in managing DKA and HHS, focusing on their responsibilities in diagnosis, treatment initiation, and communication within multidisciplinary teams. It also examines the epidemiology, pathogenesis, risk factors, and causes of these conditions, alongside diagnostic criteria and management strategies. In addition, the review highlights the importance of minimising risks and preventing recurrence to ultimately enhance patient outcomes.
Diabetic emergencies represent acute, life-threatening complications requiring immediate medical intervention (Khan and Salman, 2024). Among these, diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) are particularly critical conditions encountered in patients with diabetes (Dhatariya et al, 2020a; National Institute for Health and Care Excellence (NICE), 2024a).
DKA is characterised by a triad of hyperglycaemia, ketonaemia, and metabolic acidosis (Singh et al, 2023). Notably, euglycaemic DKA can occur, presenting with normal blood glucose levels, particularly in pregnancy or in patients using sodium-glucose co-transporter 2 (SGLT2) inhibitors (such as ‘flozins’), which lower blood glucose by promoting glycosuria (Morace et al, 2024; Scottish Intercollegiate Guidelines Network, 2024).
HHS, on the other hand, is defined by severe hyperglycaemia, elevated serum osmolality, and significant dehydration (Lim and Taylor, 2024). Whereas DKA and HHS are often considered distinct entities, their clinical presentations can sometimes overlap, complicating diagnosis and management.
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