Hyperglycemic Emergencies

Adult Hyperglycemic Emergencies

In 2022, Nova Scotia Health launched standardized order sets to support the delivery of evidence-informed quality care to adults with diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS). This subject guide contains resources for physicians, nurses, pharmacists and other health care professionals to support the use of these order sets for persons with DKA and HHS at Nova Scotia Health. 

A core team of diabetes experts led this initiative:

  • Dr. Barna De (Endocrinology)
  • Shawna Boudreau, Cathy Splane and Mary Lou Martin (QEII Diabetes Case Management)
  • J.R. Manderville and Angela Wadden (Pharmacy)

The development of these orders sets was informed by:

  • Previous DKA guidelines in use in Halifax
  • Joint British Diabetes Societies for Inpatient Care Group guidelines
  • Diabetes Canada guidelines

Consultations and feedback were sought from:

  • Nursing and medicine staff at the Cobequid Community Health Centre (CCHC) and the QEII Health Sciences Centre
  • Emergency, Internal Medicine Critical Care and Intermediate Care departments
  • Provincial internists
  • Atlantic Endocrine Society

The process also included:

  • A qualitative survey of nursing and medical staff at the CCHC and the QEII, with participants providing their opinion of the previous DKA protocol
  • Quantitative data of DKA outcomes at these hospitals

These standardized orders for DKA and HHS were implemented at the CCHC and the QEII in March 2021. A provincial roll-out is set for Fall 2022.

Supporting Evidence and Education


Management of Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State in Adults (0936.01)
This course is comprised of 3 videos totalling 1 hour.