Ray S, Palui R. Managing diabetic ketoacidosis in special conditions: Difficulties and dilemmas. World J Diabetes 2025; 16(9): 109053 [DOI: 10.4239/wjd.v16.i9.109053]
Corresponding Author of This Article
Rajan Palui, MD, DM, Consultant, Department of Endocrinology, The Mission Hospital, Bidhannagar, Durgapur 713212, India. rajanpalui@gmail.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Sep 15, 2025; 16(9): 109053 Published online Sep 15, 2025. doi: 10.4239/wjd.v16.i9.109053
Managing diabetic ketoacidosis in special conditions: Difficulties and dilemmas
Sayantan Ray, Rajan Palui
Sayantan Ray, Department of Endocrinology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
Rajan Palui, Department of Endocrinology, The Mission Hospital, Durgapur 713212, India
Author contributions: Ray S conceptualized the work, performed the literature search, supervised the writing, provided intellectual input, and critically revised the manuscript; Palui R supervised the literature search and writing, provided intellectual input, and critically revised the manuscript; All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rajan Palui, MD, DM, Consultant, Department of Endocrinology, The Mission Hospital, Bidhannagar, Durgapur 713212, India. rajanpalui@gmail.com
Received: April 29, 2025 Revised: June 24, 2025 Accepted: August 8, 2025 Published online: September 15, 2025 Processing time: 136 Days and 1.8 Hours
Abstract
The management of diabetic ketoacidosis can be challenging in high-risk patients. Recent studies have reported a significant increase in diabetic ketoacidosis hospitalization rates. While managing this high-risk condition, patient factors and comorbidities should be given careful attention and consideration. Factors like pregnancy, renal disease, cardiac disease, older age, and use of sodium-glucose cotransporter-2 inhibitors all impact the treatment approach, and tailored management strategies are required. Particularly in children, specialized treatment and care during a diabetic ketoacidosis episode is necessary due to its long-term neurological consequences. However, guidelines often lack adequate recommendations about the approach to manage complex patients with specific conditions and comorbidities. Furthermore, there are still controversies around certain aspects of diabetic ketoacidosis management, and additional investigations are needed to determine the best management options. We aim to address these special conditions and provide an approach to manage complex patients with specific conditions and co-morbidities.
Core Tip: Diabetic ketoacidosis is the most common life-threatening acute complication of uncontrolled hyperglycemia. The concurrent presence of co-morbid conditions in patients with diabetic ketoacidosis can further worsen the clinical scenario. While standard guidelines exist for the treatment of diabetic ketoacidosis, the management of these high-risk patients requires careful modifications from the standard treatment protocol. In this review, we summarize the management principles of diabetic ketoacidosis in co-morbid conditions, in special populations (children, pregnancy and elderly) and in different atypical forms (Euglycemic diabetic ketoacidosis, diabetic ketoacidosis- hyperosmolar hyperglycemic state overlap).
