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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.

Endocrinology and Metabolism Clinics of North America

|February 8, 2026

Summary

This summary is machine-generated.

Hyperosmolar hyperglycemic state (HHS) is a serious diabetic emergency. Prompt recognition and treatment, including aggressive fluid replacement and insulin therapy, are crucial for managing this condition.

Keywords:

Altered mental status Diabetic emergency Endocrine emergency Hyperglycemia Hyperosmolar hyperglycemic state Hyperosmolar nonketotic state

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Area of Science:

Endocrinology
Internal Medicine
Emergency Medicine

Background:

Hyperosmolar hyperglycemic state (HHS) is a severe diabetic complication.
HHS presents with high morbidity and mortality.
Features of HHS can overlap with diabetic ketoacidosis, necessitating careful differentiation.

Purpose of the Study:

To summarize the key characteristics of HHS.
To highlight diagnostic differentiators between HHS and diabetic ketoacidosis.
To outline current treatment recommendations for HHS.

Main Methods:

Review of existing literature and clinical guidelines.
Analysis of diagnostic criteria for HHS.
Synthesis of recommended therapeutic interventions.

Main Results:

Key HHS indicators include serum osmolality >320 mOsm/kg, absence of metabolic acidosis, and minimal ketones.
Common triggers for HHS are infections, stroke, and acute coronary syndromes.
Effective treatment involves aggressive volume repletion and insulin therapy, alongside addressing the underlying cause.

Conclusions:

HHS is an underrecognized but critical diabetic emergency.
Accurate diagnosis relies on specific laboratory values and clinical context.
Timely and comprehensive management is essential to improve patient outcomes.