Managing diabetic ketoacidosis in special conditions: Difficulties and dilemmas

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.