Introduction: Diabetes mellitus comprises a spectrum of metabolic disorders characterised by chronic hyperglycaemia arising from inadequate insulin secretion, impaired insulin action, or both; acute metabolic complications (AMCs) are abrupt metabolic derangements directly related to the natural history of diabetes. We sought to quantify the frequency of AMCs among emergency department admissions, describe their epidemiological and diagnostic profiles, and identify factors associated with their occurrence. Methods: Twelve-month retrospective descriptive analytic study at the Emergency Department of the National Hospital Center Cheikh Ahmadoul Khadim (Touba), including all adults (≥18 years) with known or newly diagnosed diabetes admitted for an AMC. Variables covered demographics, diabetes characteristics, presentation, precipitants, management, and short-term outcomes. Results: Among 141 eligible records, AMCs accounted for 1.8% of admissions. Mean age was 55 ± 15 years ; male-to-female ratio 1.27. Type 2 diabetes predominated (93.7%) ; duration <5 years in 53.1%. Fourteen percent were not on antidiabetic therapy; hypertension coexisted in 21.13%. The commonest presenting complaint was classic hyperglycaemic symptoms (polyuria–polydipsia) (28.4%). AMC types were isolated hyperglycaemia 62.4%, diabetic ketoacidosis 31.2%, and severe hypoglycaemia 6.4% ; in 21.27%, the AMC revealed previously undiagnosed diabetes. Principal precipitants were infection (34.75% ; with skin/soft-tissue sites in 48.9% of infections), drug-related causes (34%), and non-adherence (14%). Management yielded rapid stabilisation : 56% were observed for <24 hours, while 44% required admission (mean length of stay 2.1 ± 1.8 days). No in-hospital deaths occurred. Conclusions: In this referral emergency setting, AMCs represent a meaningful yet manageable burden and function as a barometer of diabetes care quality. Their frequency sometimes without an obvious trigger underscores gaps in screening, therapeutic education, and access to specialised care. These findings support strengthened prevention, standardised emergency department protocols, and system-level organisation of diabetes services.