Diabetes Emergencies: DKA and HHS

By VeriScorePrep Team · 6 min

Two hyperglycemic emergencies — DKA and HHS — share some signs but differ in ketoacidosis and typical onset.

DKA (diabetic ketoacidosis)

Most common in type 1, often with infection, missed insulin, or new onset. Hyperglycemia (often >250–300 mg/dL) with ketones and metabolic acidosis. Hallmarks: Kussmaul (deep, rapid) respirations, fruity (acetone) breath, nausea/vomiting, abdominal pain, dehydration, altered sensorium. Potassium looks normal initially but drops sharply with insulin — monitor closely.

HHS (hyperosmolar hyperglycemic state)

More common in type 2, older adults. Extreme hyperglycemia (often >600 mg/dL) with profound dehydration and altered mental status or coma, but minimal or no ketosis. Onset is insidious over days.

Nursing priorities

• IV fluids first (the most important initial step), then insulin per protocol.
• Replace electrolytes, especially potassium, guided by frequent labs.
• Identify and treat the trigger (infection, missed doses, infarction).
• Monitor neurologic status; rapid correction can cause cerebral edema, especially in younger patients.

Teaching

Sick-day rules, ketone testing, regular insulin adherence, and early provider contact for illness or unexplained hyperglycemia prevent most DKA episodes.