Hyperosmolar hyperglycemic state
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At the time the article was created Yuranga Weerakkody had no recorded disclosures.View Yuranga Weerakkody's current disclosures
At the time the article was last revised Daniel J Bell had no financial relationships to ineligible companies to disclose.View Daniel J Bell's current disclosures
Hyperosmolar hyperglycemic state (HHS) (previously known as hyperosmolar non-ketotic coma (HONK)) is a serious metabolic derangement that can occur in patients with diabetes mellitus, predominantly those with type 2. While there are no distinct imaging features, it is useful for a radiologist to be familiar with this condition.
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It usually occurs in type 2 diabetics who have some concomitant illness that leads to reduced fluid intake. The typical patient is 50-70 years old and there may be a precipitating event such as a stroke, MI, chest/urinary infection or systemic inflammatory response 2.
Due to hypovolemia, patients are at increased risk of thromboembolic disease, which may be a presenting complaint or complicate hospital management 3.
High blood glucose levels lead to severe dehydration, increases in osmolarity (relative concentration of solute) and, in turn, carries a high risk of complications, coma, and death.
Treatment and prognosis
Hyperosmolar hyperglycemic state is common in more elderly diabetic patients and is associated with volume depletion without compensating fluid intake. Principles of management are as follows 2:
correction of volume depletion with intravenous fluids
insulin infusion to correct high blood sugar levels (BSLs)
rehydration often produces significant reductions in BSLs and HHS patients often require less insulin than diabetic ketoacidosis (DKA) patients
BSL and electrolyte monitoring
search for precipitating cause
History and etymology
Hyperosmolar hyperglycemic state is thought to have been first described by von Frerichs and Dreschfeld in the 1880s 1.
- 1. Pasquel F & Umpierrez G. Hyperosmolar Hyperglycemic State: A Historic Review of the Clinical Presentation, Diagnosis, and Treatment. Diabetes Care. 2014;37(11):3124-31. doi:10.2337/dc14-0984 - Pubmed
- 2. Shane A. Marshall, John Ruedy. On Call Principles and Protocols. (2016) ISBN: 9780323479769 - Google Books
- 3. Milano A, Tadevosyan A, Hart R, Luizza A, Eberhardt M. An Uncommon Complication of Hyperosmolar Hyperglycemic State: Bilateral Above Knee Amputations. Am J Emerg Med. 2016;34(2):341.e1-2. doi:10.1016/j.ajem.2015.06.023 - Pubmed