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BACKGROUND: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemia (HH) remain life-threatening complications of diabetes mellitus. Herein, we evaluated a standardized protocol for the therapy of acute hyperglycemic crises. PATIENTS AND METHODS: Retrospective study of patients treated in a medical intensive care unit for acute and severe hyperglycemia. Therapy was standardized according to internal guidelines effective for all treating physicians. RESULTS: 24 diabetic patients (11 men, 13 women, age 54 +/- 16 years, 11 DKA, 13 HH) were included into this study. All except one patient in the DKA-group had diabetes mellitus type 1. All patients with HH had diabetes mellitus type 2. Patients with DKA were significantly younger and complained more often about nausea and vomiting compared to the HH-group. Infections were the major cause for acute hyperglycemia followed by non-compliance. The arterial pH-value in the DKA-group was lower than in the HH-group (7,07 +/- 0,12 vs. 7,36 +/- 0,05). The length of stay in the intensive care unit was 1,8 +/- 1,2 days in patients with DKA and 2,2 +/- 1,2 days in patients with HH. The length of stay in the hospital was 11,5 +/- 5,9 days in patients with DKA and 18,3 +/- 10,9 days in patients with HH. No patient died during hospitalization. CONCLUSION: This study emphasizes the relevance of standardized written guidelines for the therapy of acute hyperglycemic crises in diabetic patients.