Rapid Recovery From Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State in Two Patients With Severe Hyperglycemia

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are acute, life-threatening complications of diabetes. The overlap of these conditions, termed hyperosmolar diabetic ketoacidosis (H-DKA), is associated with substantial morbidity due to its complex pathophysiology and high complication rates. Notably, cases of H-DKA with glucose levels exceeding 50 mmol/L are rarely reported in the literature. This study details the clinical course of two H-DKA patients who exhibited extreme hyperglycemia at presentation, despite having no prior diagnosis of diabetes. Both patients underwent aggressive fluid resuscitation and insulin therapy, alongside careful management of acute complications. Vital signs and laboratory parameters demonstrated substantial normalization within 3 days of treatment initiation, and no acute or long-term complications related to the therapeutic interventions were observed. These cases underscore the efficacy of timely and intensive therapeutic interventions in mitigating the risks associated with extreme hyperglycemia in H-DKA and highlight critical strategies for optimal patient outcomes.