Fluid and Electrolyte Management in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemia State in the Emergency DepartmentIntroductionDiabetes mellitus is a growing problem for healthcare providers healthcare internationally. The World Health Organization estimated in 2013 that there were 347 million diabetics worldwide, predicting that diabetes will be the 7th leading cause of death by 2030 (WHO, 2013). In type 1 and type 2 diabetes mellitus, factors such as poor adherence to diet and medications, infection, acute medical or surgical illness, or trauma can lead to poor glycemic control, precipitating an emergency. hyperglycemic such as diabetic ketoacidosis (DKA) (Scobie & Samaras, 2009). In type 2 diabetes, another equally dangerous complication can occur, called the hyperosmolar and hyperglycemic state (HHS) (Dunning, 2009). Both DKA and HHS are characterized by dehydration resulting from osmotic diuresis (Kisiel & Marsons 2009), often compounded by the patient already being in a state of dehydration due to the underlying cause (Del Garcia -Pascual & Kidby, 2012). It is therefore imperative that when a patient presents to the emergency room, rehydration and electrolyte replacement are an integral part of treatment. Monash Health has developed protocols to treat DKA and HHS, much of which focuses on rehydration and electrolyte management. This review will discuss the mechanisms of dehydration in DKA and HHS, the importance of effective rehydration and electrolyte management in both conditions; examine the differences between DKA and HHS in terms of onset, volume deficit and electrolyte changes, and compare best practice recommendations with policies currently adopted by Monash Health. What are DKA and HHS? The DKA is...... middle of paper. .....=eds-live Pamaiahgari, P. (2014). Diabetic ketoacidosis and nonketotic hyperosmolar hyperglycemic syndrome: information for clinicians. The Joanna Briggs Institute. Retrieved from: http://www.Joannabriggs.org Raghaven, VA (2014). Treatment and management of diabetic ketoacidosis. Medscape references, drugs, diseases and procedures. Retrieved from: http://emedicine.medscape.com/article/118361-treatment#aw2aab6b6b2Scobie, I. and Samaras, K. (2009) Highlights: Diabetes Mellitus (3rd ed.) Retrieved from: http://monash. worldcat.org/title/fast-facts-diabetes-mellitus/oclc/797833912&referer=brief_resultsVenkatraman, R. and Singhi,SC (2006) Non-ketotic hyperosmolar hyperglycemic syndrome. Indian Journal of Pediatrics (Vol 73), 55-60. DOI: 10.1007 BF02758261WHO (2013) Diabetes Fact Sheet No. 312. Retrieved from http://www.who.int/mediacentre/factsheets/fs312/en/