With increasing incidence of diabetes mellitus, complications associated with it are also increasing. The hyperglycemic hyperosmolar state (HHS) is one of the common complications seen in old diabetics where patients have markedly increased serum glucose concentrations and hyperosmolality in absence of significant ketosis. Most common precipitating factor is infection. In HHS, levels of insulin in circulation reduce significantly while counterregulatory or stress hormones such as cortisol, catecholamines, glucagon, and growth hormone increase along with greater degree of dehydration. Hence, these patients, in addition to typical features of diabetes, generally present with dehydration and progressive mental deterioration. Basic hematological, biochemical, and radiological investigations are important to find and rule out precipitating factors and complications. Aggressive correction of the fluid and electrolyte imbalance along with the maintaining levels of insulin are very important components of the treatment. Simultaneously, identification and treatment of any underlying precipitating events should be done. Awareness, early diagnosis, and aggressive proper treatment play very crucial role in preventing the morbidity and mortality associated with HHS, which is 10 times more than diabetic ketoacidosis.
Wachtel TJ, Silliman RA, Lamberton P. Prognostic factors in the diabetic hyperosmolar state. J Am Geriatr Soc 1987;35(8):737–741. DOI: 10.1111/j.1532-5415.1987.tb06351.x.
Care D, Suppl SS. Classification and diagnosis of diabetes: Standards of medical care in diabetes 2019. Diabetes Care 2019;42(January):S13–S28.
Gerich JE, Martin MMRL. Clinical and metabolic characteristics of hyperosmolar nonketotic coma. Diabetes 1971;20(4):228–238. DOI: 10.2337/diab.20.4.228.
Dhatariya KK, Vellanki P, Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Advances in the Management of Hyperglycemic Crises (UK Versus USA). 2017.
Wachtel TJ, Silliman RALP. Predisposing factors for the diabetic hyperosmolar state. Arch Intern Med 1987;147(3):499–501. DOI: 10.1001/archinte.1987.00370030103020.
Chupin M, Charbonnel BCF. C-peptide blood levels in keto-acidosis and in hyperosmolar non-ketotic diabetic coma. Acta Diabetol Lat 1981;18(2):123–128. DOI: 10.1007/BF02098997.
Nugent BW. Hyperosmolar hyperglycemic state. Emerg Med Clin North Am 2005;23(3):629–648. DOI: 10.1016/j.emc.2005.03.006.
Maletkovic JDA. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Endocrinol Metab Clin North Am 2013;42(4):677–695. DOI: 10.1016/j.ecl.2013.07.001.
Np K. Hyperosmolar Hyperglycemic nonketotic coma (HHNC, hyperosmolar Hyperglycemic Nonketotic syndrome). 2019. 1–7.
Slovis CM, Mork VG, Slovis RJBR. Diabetic ketoacidosis and infection: leukocyte count and differential as early predictors of serious infection. Am J Emerg Med 1987;5(1):1–5. DOI: 10.1016/0735-6757(87)90280-4.
Baldrighi M, Sainaghi PP, Bellan M, et al. Hyperglycemic hyperosmolar state: A pragmatic approach to properly manage sodium derangements. Curr Diabetes Rev 2018;14(6):534–541. DOI: 10.2174/1573399814666180320091451.
Scott AR. Joint British Diabetes Societies (JBDS) for inpatient care JBDS hyperosmolar hyperglycemic guidelines group. management of hyperosmolar hyperglycaemic state in adults with diabetes. Diabet Med 2015;32(6):714–724. DOI: 10.1111/dme. 12757.
Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes. Diabetes Care 2009;32(7):1335–1343. DOI: 10.2337/dc09-9032.
French EK, Donihi AC, Korytkowski MT, State of the Art Review Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. 2019.
Whelton MJ, Walde DHC. Hyperosmolar non-ketotic diabetes coma – with particular reference to vascular complications. BMJ 1971;1(5740):85–86. DOI: 10.1136/bmj.1.5740.85.
Keenan CR, Murin SWR. High risk for venous thrombo- embolism in diabetics with hyperosmolar state: comparison with other acute medical illnesses. J Thromb Haemost 2007;5(6):1185–1190. DOI: 10.1111/j.1538-7836.2007.02553.x.