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Hyperosmolar hyperglycemic state.

Gregg D Stoner1

  • 1University of Illinois College of Medicine, Peoria, Illinois 61602, USA. gstoner@uic.edu

American Family Physician
|May 13, 2005
PubMed
Summary

Hyperosmolar hyperglycemic state (HHS) is a dangerous diabetic emergency. Prompt treatment with fluids, electrolytes, and insulin is crucial for managing blood glucose and preventing severe complications.

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Hyperosmolar Hyperglycemic State.

American family physicianยท2018
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Area of Science:

  • Endocrinology
  • Internal Medicine
  • Emergency Medicine

Background:

  • Hyperosmolar hyperglycemic state (HHS) is a severe diabetic emergency characterized by hyperglycemia, hyperosmolarity, and absence of ketosis.
  • Increasing prevalence of type 2 diabetes and an aging population suggest family physicians will encounter HHS more frequently.
  • Underlying infections are the most common precipitating cause, but medications, non-compliance, and other factors also contribute.

Purpose of the Study:

  • To outline the key features, causes, and management strategies for hyperosmolar hyperglycemic state.
  • To emphasize the critical importance of prompt diagnosis and treatment in preventing life-threatening complications.

Main Methods:

  • Summarizes clinical presentation including dehydration and neurological symptoms.
  • Details treatment protocols: initial fluid resuscitation with normal saline, potassium replacement, and insulin therapy (bolus followed by infusion).
  • Highlights the necessity of identifying and treating precipitating causes and monitoring for complications.

Main Results:

  • Vigorous fluid correction (average 9 L/48h) is essential.
  • Insulin therapy initiated after urine output is established.
  • Close monitoring for complications like vascular occlusions and rhabdomyolysis is vital.

Conclusions:

  • Effective management of HHS requires aggressive fluid and electrolyte replacement, followed by insulin therapy.
  • Addressing underlying causes and preventing future episodes through patient education are critical components of care.
  • Early recognition and management can significantly improve patient outcomes and reduce mortality associated with this emergency.

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