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Hyperglycaemic crises and lactic acidosis in diabetes mellitus
  1. P English1,
  2. G Williams2
  1. 1Diabetes and Endocrinology Research Group, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK
  2. 2Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK
  1. Correspondence to:
 Dr Patrick English
 Diabetes and Endocrinology Research Group, 3rd Floor Clinical Sciences Centre, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK;


Diabetic ketoacidosis, hyperglycaemic hyperosmolar state, and lactic acidosis represent three of the most serious acute complications of diabetes. There have been some advances in our understanding of the pathogenesis of these conditions over the last three decades, together with more uniform agreement on their treatment and innovations in technology. Accordingly their incidence, morbidity, and mortality are decreasing, but at rates that fall short of our aspirations. Hyperglycaemic crises in particular remain an important cause of morbidity and mortality in diabetic populations around the world. In this article, understanding of these conditions and advances in their management, and the available guidelines for their treatment, are reviewed. As far as is possible, the recommendations are based on clear published evidence; failing that, what is considered to be a common sense synthesis of consensus guidelines and recommendations is provided.

  • diabetes mellitus
  • lactic acidosis
  • ketoacidosis
  • DKA, diabetic ketoacidosis
  • FFA, free fatty acids
  • HHS, hyperglycaemic hyperosmolar state

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