Management of Hyperglycaemic Emergencies in the Tropics

Diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar state are the two most serious acute metabolic complications of diabetes even if managed properly. These disorders can occur in both types 1and 2 diabetes, and remain an important cause of morbidity and mortality in diabetic populations especially, in the developing countries. Intravenous insulin and fluid replacement are the mainstays of therapy, with careful monitoring of potassium levels. Bicarbonate therapy is rarely needed. Infection, omission of insulin, and other precipitating factors should be treated. This review is intended to discuss some of the advances in the management of hyperglycaemic emergencies and also to highlight some of the peculiarities of the management of hyperglycaemic emergency in our setting if we are going to be able to improve outcome significantly.