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 mucus 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 serum osmolality >340 mOsm/kg.
- Treatment includes correction of fluid deficit and electrolyte abnormalities, and intravenous insulin.
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History & Exam
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Definition
Epidemiology
Etiology
Pathophysiology
Citations
Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009 Jul;32(7):1335-43.[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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