Hyperglycemic crises, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), are severe metabolic complications of diabetes mellitus. Both conditions require immediate medical attention due to their potential to cause life-threatening complications. DKA is characterized by hyperglycemia, ketonemia, and metabolic acidosis, while HHS is marked by hyperosmolality, high blood glucose, and minimal ketosis. Although DKA and HHS are often treated as distinct conditions, they are part of a spectrum of hyperglycemic emergencies. DKA is more common in type 1 diabetes, while HHS is more frequent in type 2 diabetes. Both conditions involve inadequate insulin action, leading to hyperglycemia and the breakdown of fat into ketone bodies. Diagnosis involves assessing blood glucose, ketones, electrolytes, and osmolality. Treatment includes intravenous fluids, insulin, and management of underlying causes. Fluid resuscitation is crucial, especially in HHS. Insulin therapy is the cornerstone of treatment, with adjustments based on blood glucose levels. Potassium management is also important, as insulin can cause potassium shifts. Bicarbonate therapy is not recommended for DKA due to limited clinical benefits. Transitioning to maintenance insulin regimens is essential after crisis resolution. Early diagnosis and prompt treatment are vital to prevent complications and improve outcomes. Further research is needed to refine diagnostic criteria and treatment strategies for these conditions.Hyperglycemic crises, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), are severe metabolic complications of diabetes mellitus. Both conditions require immediate medical attention due to their potential to cause life-threatening complications. DKA is characterized by hyperglycemia, ketonemia, and metabolic acidosis, while HHS is marked by hyperosmolality, high blood glucose, and minimal ketosis. Although DKA and HHS are often treated as distinct conditions, they are part of a spectrum of hyperglycemic emergencies. DKA is more common in type 1 diabetes, while HHS is more frequent in type 2 diabetes. Both conditions involve inadequate insulin action, leading to hyperglycemia and the breakdown of fat into ketone bodies. Diagnosis involves assessing blood glucose, ketones, electrolytes, and osmolality. Treatment includes intravenous fluids, insulin, and management of underlying causes. Fluid resuscitation is crucial, especially in HHS. Insulin therapy is the cornerstone of treatment, with adjustments based on blood glucose levels. Potassium management is also important, as insulin can cause potassium shifts. Bicarbonate therapy is not recommended for DKA due to limited clinical benefits. Transitioning to maintenance insulin regimens is essential after crisis resolution. Early diagnosis and prompt treatment are vital to prevent complications and improve outcomes. Further research is needed to refine diagnostic criteria and treatment strategies for these conditions.