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Hyperglycemic Hypernatremic Hypertonic State: A Predominant HHS Subtype and Its Clinical and Diagnostic Features
Siyuan Cao1, Shanjin Cao2,3
1Pulmonary and Critical Care Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA.
The Journal of Clinical Endocrinology and Metabolism
|July 21, 2025
Summary
Hyperglycemic hyperosmolar state (HHS) with hypernatremia is common when corrected for blood sugar. This subtype requires updated diagnostic criteria for better patient management.
Area of Science:
- Endocrinology
- Internal Medicine
- Nephrology
Background:
- Hyperglycemic hyperosmolar state (HHS) with concurrent hypernatremia is an emerging and under-investigated subtype.
- This subtype is characterized by elevated blood glucose and sodium levels, posing diagnostic challenges.
Purpose of the Study:
- To investigate the clinical characteristics, prevalence, and diagnostic parameters of HHS with concurrent hypernatremia.
- To determine the most sensitive diagnostic criteria for this HHS subtype.
Main Methods:
- Retrospective study of adult patients admitted with HHS (2018-2024).
- Assessment of measured and corrected sodium levels, free water deficit, effective and total serum osmolarity.
- Evaluation of coexisting diabetic ketoacidosis (DKA) and metabolic acidosis.
Main Results:
- Hypernatremia based on corrected sodium was highly prevalent (95.4%) in HHS patients.
- Effective serum osmolarity > 300 mOsm/L was more sensitive for diagnosing HHS than total serum osmolarity.
- 65.5% of HHS cases had concurrent DKA, challenging traditional diagnostic exclusions.
Conclusions:
- HHS with hypernatremia, defined by corrected sodium, is the predominant and clinically relevant subtype.
- Effective serum osmolarity > 300 mOsm/L is a more sensitive diagnostic criterion for HHS.
- Reevaluation of DKA and acidosis exclusion criteria in HHS diagnosis is warranted for improved accuracy and personalized fluid management.
Keywords:
effective serum osmolarityfree water deficithyperglycemic hyperosmolar statehypernatremiaserum osmolalitytotal serum osmolarityMore Related Videos
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