- Diabetic ketoacidosis and the hyperglycemic hyperosmolar non-ketotic state are potentially lethal acute complications of diabetes mellitus. Although well recognized and understood, these syndromes can present in unusual circumstances. The association between carbohydrate metabolism and chronic liver disease is well established. Sixty to 80% of cirrhotic patients have demonstrable abnormalities of glucose metabolism, with 10±30% of them being overt diabetics , yet neither DKA nor a hyperglycemic heyperosmolar non-ketotic state has been described in cirrhotic patients. We present the case of a previously non-diabetic cirrhotic male who developed severe HHNS that resolved without the development of chronic diabetes mellitus.