Emergency Medical Minute20 Jun 2022

Podcast 791: Hyperglycemic Hyperosmolar State

Contributor: Aaron Lessen, MD

Educational Pearls:

Hyperglycemic Hyperosmolar State (HHS) is less common than Diabetic Ketoacidosis (DKA) but is associated with a mortality rate up to 10 times greater than that seen in DKA
Typically seen in elderly patients with severely elevated blood glucose levels (>1000 mg/dL) and an increased plasma osmolality
- Unlike in DKA, patients with HHS do not have elevated ketones
Treatment of HHS includes insulin administration along with correcting fluid and electrolyte abnormalities
When treating HHS, it is important to monitor and follow osmolality regularly because over-rapid correction can result in the development of cerebral edema

References

Fayfman M, Pasquel FJ, Umpierrez GE. Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. Med Clin North Am. 2017;101(3):587-606.

Gosmanov AR, Gosmanova EO, Kitabchi AE. Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. In: Feingold KR, Anawalt B, Boyce A, et al., eds. Endotext. South Dartmouth (MA): MDText.com, Inc. Copyright © 2000-2022, MDText.com, Inc.; 2000.

Long B, Willis GC, Lentz S, Koyfman A, Gottlieb M. Diagnosis and Management of the Critically Ill Adult Patient with Hyperglycemic Hyperosmolar State. J Emerg Med. 2021;61(4):365-375.

Summarized by Mark O'Brien, MS4 | Edited by John Spartz MS4 & Erik Verzemnieks, MD

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