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Highlights & Basics
- Hyperosmolar hyperglycemic state (HHS) occurs most commonly in older patients with type 2 diabetes. Contributes to less than 1% of all diabetes-related admissions. However, mortality is high (5% to 20%).
- Presents with polyuria, polydipsia, weakness, weight loss, tachycardia, dry mucous membranes, poor skin turgor, hypotension, and, in severe cases, shock.
- Altered sensorium (lethargy, disorientation, stupor) is common and correlates best with effective serum osmolality. Coma is rare and, if seen, is usually associated with a total serum osmolality >340 mOsm/kg.
- Treatment includes correction of fluid deficit and electrolyte abnormalities, and intravenous insulin.
Quick Reference
History & Exam
Key Factors
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Definition
Epidemiology
Etiology
Pathophysiology
Citations
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Mustafa OG, Haq M, Dashora U, et al. Management of hyperosmolar hyperglycaemic state (HHS) in adults: an updated guideline from the Joint British Diabetes Societies (JBDS) for inpatient care group. Diabet Med. 2023 Mar;40(3):e15005.[Abstract][Full Text]
Diabetes Canada Clinical Practice Guidelines Expert Committee, Goguen J, Gilbert J. Hyperglycemic emergencies in adults. Can J Diabetes. 2018 Apr;42(suppl 1):S109-14.[Abstract][Full Text]
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