Dr. Nadine Palermo, an endocrinologist and the Associate Director of the Acute Diabetes Care program at Brigham and Women’s Hospital, talks with Joyce Zhou (host) and Jakub Glowala (case presenter) to discuss acute hyperglycemic episodes. The discussion begins with a case of a patient presenting with dehydration, altered mental status, emesis, and suspected symptomatic hyperglycemia. Dr. Palermo then brings us up to speed on the pathophysiology behind diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), underscoring the role of osmotic diuresis and counter-regulatory hormones in exacerbating the two conditions. Dr. Palermo instructs us on the “classic” signs of a patient presenting with DKA, while cautioning us against relying solely on these textbook findings, as the workup often involves a holistic combination of BMP, urinalysis, ABG/VBGs, and history-taking. The episode closes with a discussion of DKA and HHS treatment, in addition to some clinical pearls.