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Hyperosmolar hyperglycemic state.

American family physician·2005

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Hyperosmolar Hyperglycemic State.

Gregg D Stoner¹

¹University of Illinois College of Medicine, Peoria, IL, USA.

American Family Physician

|February 13, 2018

Summary

The hyperosmolar hyperglycemic state (HHS) is a critical diabetes complication. Prompt fluid and electrolyte correction, insulin therapy, and addressing underlying causes are vital for managing this emergency.

Area of Science:

Endocrinology
Internal Medicine
Emergency Medicine

Background:

Hyperosmolar hyperglycemic state (HHS) is a severe, life-threatening diabetic emergency.
It is characterized by extreme hyperglycemia and hyperosmolarity with minimal ketosis.
Infections are the most frequent precipitating cause, particularly in children and adolescents diagnosed with type 2 diabetes.

Purpose of the Study:

To summarize the key features, diagnosis, and management of hyperosmolar hyperglycemic state.
To highlight the critical role of prompt and aggressive treatment in improving patient outcomes.

Main Methods:

Review of clinical presentation, diagnostic criteria, and therapeutic strategies for HHS.
Emphasis on intensive monitoring of glucose, electrolytes, and fluid balance.

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Detailed description of fluid resuscitation, electrolyte replacement, and insulin administration protocols.

Main Results:

Profound dehydration and neurological deficits (lethargy to coma) are hallmark physical findings.
Treatment requires substantial fluid replacement (average 9 L saline in adults over 48 hours) and potassium correction.
Insulin therapy is initiated after partial dehydration correction, with specific protocols for adults and children to prevent cerebral edema.

Conclusions:

Effective management of HHS hinges on rapid identification and treatment of precipitating factors, alongside meticulous fluid, electrolyte, and insulin management.
Early and aggressive intervention is crucial for reducing morbidity and mortality associated with this condition.