Endocrine emergencies and electrolytes

Hyperglycaemia — acute assessment

Overview and approach

Hyperglycaemia may reflect diabetes, stress or medicines; determine whether DKA/HHS is present.

  • Hyperglycaemia is high blood glucose from too little insulin or inadequate insulin action. Queensland criteria list diabetic ketoacidosis, diabetes with severe vomiting, acute severe hyperglycaemia and HHS as emergency presentations (1).
  • Non-diabetes causes: acromegaly (excess GH), Cushing syndrome (insulin resistance), chronic pancreatitis, haemochromatosis (pancreatic iron damage), prolonged steroids, glucagonoma. Insulinoma causes hypoglycaemia instead.
Assessment and clinical features

Vitals, hydration, mental state, vomiting, abdominal pain, infection and insulin omission.

  • Early: polyuria, polydipsia, polyphagia, blurred vision, tiredness. Later: dry mouth, abdominal pain, nausea and vomiting, breathlessness, fruity breath, confusion, loss of consciousness, fever.
  • Risk factors: insufficient or incorrect insulin or expired insulin, diet, inactivity, illness or infection, steroids or immunosuppressants, injury or surgery, emotional stress.
Differentials and investigations

Glucose, ketones, electrolytes, venous pH/bicarbonate and osmolality assessment as indicated.

  • Capillary or blood ketones, venous gas, electrolytes, renal function, osmolality, infection screen and ECG. See the DKA and HHS pages for the diagnostic criteria.
Management and follow-up

Treat precipitant and use a monitored local pathway for fluids/insulin/electrolytes when crisis is present.

  • Use your hospital DKA/HHS protocol for fluids, insulin and potassium (see those pages).
  • Complications to prevent: DKA, HHS, cardiovascular disease, neuropathy, nephropathy, retinopathy, foot ulcers and infections, dental infections.
Red flags and clinical pearls

SGLT2-associated ketoacidosis may occur without marked hyperglycaemia. Do not use glucose alone to exclude DKA.

References
  1. Queensland Health CPC: Diabetes mellitus

Last updated from Sen’s notes on 9 October 2026.