Hyperglycemic Crisis in the Eastern Cape Province of South Africa: High Mortality and Association of Hyperosmolar Ketoacidosis with a New Diagnosis of Diabetes (Original Articles) (Clinical Report‪)‬

Diabetic hyperglycaemic crisis is a major reason for high-care unit admissions, (1) with mortality rates of up to 30%. (2-9) It is characteristically classified as ketoacidotic or hyperosmolar.10 Presentations with the combination of ketoacidosis and hyperosmolality are recognised, (6,7,11-16) and have variably been described as ketoacidosis with hyperosmolality or hyperosmolar state with ketoacidosis, depending on whether ketoacidosis or hyperosmolality was considered dominant. (15) Therapy and outcome of treatment for hyperglycaemic crisis is related to the presence of hyperosmolality and ketoacidosis. (1) Hyperosmolality is associated with the use of hypotonic fluids, anticoagulation and the more frequent occurrence of vascular thrombosis, (17) while ketoacidosis may necessitate the use of sodium bicarbonate. (18)