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Hyperosmolar Hyperglycemic State.

Spencer S Lovegrove1, Sarah B Dubbs1

  • 1Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor Suite 200, Baltimore, MD 21201, USA.

Emergency Medicine Clinics of North America
|September 27, 2023
PubMed
Summary
This summary is machine-generated.

Hyperosmolar hyperglycemic state (HHS) is a serious diabetic emergency. Key indicators include high serum osmolality and no ketones, requiring aggressive fluid and insulin therapy alongside treating the trigger illness.

Keywords:
Altered mental statusDiabetic emergencyEndocrine emergencyHyperglycemiaHyperosmolar hyperglycemic stateHyperosmolar nonketotic state

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Area of Science:

  • Endocrinology
  • Internal Medicine
  • Emergency Medicine

Background:

  • Hyperosmolar hyperglycemic state (HHS) is a critical diabetic emergency.
  • HHS presents with high morbidity and mortality rates.
  • It is often underrecognized in clinical practice.

Purpose of the Study:

  • To differentiate HHS from diabetic ketoacidosis (DKA).
  • To highlight key diagnostic features of HHS.
  • To outline recommended treatment strategies for HHS.

Main Methods:

  • Comparison of HHS and DKA clinical features.
  • Identification of specific diagnostic markers for HHS.
  • Review of current treatment guidelines for HHS.

Main Results:

  • HHS is distinguished by serum osmolality >320 mOsm/kg.
  • Absence of metabolic acidosis and minimal ketones are key differentiators.
  • Common triggers include infections, stroke, and acute coronary syndrome.

Conclusions:

  • Prompt recognition and differentiation from DKA are crucial for HHS management.
  • Aggressive volume repletion and insulin therapy are primary treatment components.
  • Addressing the underlying precipitating illness is essential for successful HHS treatment.