Treatment of Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS): management in emergency area

The treatment of hyperglycemia is a common issue among physicians, especially those working in the Emergency-Urgency departments. The aim of this study is to suggest a practical and immediate Operating Protocol for the management of hyperglycemia in this context. This protocol was created by the inter-society AMD-SID-SIEDP-SIMEU-SIMEUP project group set up in the Lazio Region and subsequently subjected to validation by the AMD Diabete e Inpatient Project Group. The multidisciplinary working group, after examining the literature available on PubMed, selected the most recent bibliographic sources suitable. We created this operating protocol that allows a rapid differential diagnosis of four possible scenarios (moderate/severe hyperglycemia; hyperglycemia and ketosis; hyperglycemia and ketoacidosis; hyperglycemia and hyperosmolarity) and, thanks to the quickly available flow-charts, it represents a rapid therapeutic choice for the physicians. We underline the most important lab tests to be performed and monitored and we focused, indeed, on the goals to be achieved when the patient is ready to exit the protocol. The flow charts were designed to be printed and used in the Emergency Area for quick reference. The proposed operating protocol is an attempt to simplify the therapeutic protocols present in literature for the management of hyperglycemia in the emergency setting, based on both the experience, the needs and the habits of ER physicians and diabetologists. The correct management of hyperglycemic emergencies undoubtfully leads to a reduction in patients’ morbidity and mortality and consequently to a reduction in global healthcare costs, so that we strongly believe the usefulness of this protocol. KEY WORDS diabetic ketoacidosis; hyperglycemic hyperosmolar state; management of hyperglycemic crises; emergency area.