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Endocrinol Metab Clin North Am. 2013 Dec;42(4):677-95. doi: 10.1016/j.ecl.2013.07.001.

Diabetic ketoacidosis and hyperglycemic hyperosmolar state.

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Department of Endocrinology, UCLA School of Medicine, Gonda Diabetes Center, 200 UCLA Medical Plaza, Suite 530, Los Angeles, CA 90095, USA. Electronic address:


Diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state (HHS) are potentially fatal hyperglycemic crises that occur as acute complications of uncontrolled diabetes mellitus. The authors provide a review of the current epidemiology, precipitating factors, pathogenesis, clinical presentation, evaluation, and treatment of DKA and HHS. The discovery of insulin in 1921 changed the life expectancy of patients with diabetes mellitus dramatically. Today, almost a century later, DKA and HHS remain significant causes of morbidity and mortality across different countries, ages, races, and socioeconomic groups and a significant economic burden for society.


Diabetes mellitus; Hyperglycemic crisis; Hyperosmolar state; Ketoacidosis

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