What Is a Hyperglycemic Hyperosmolar State?

A hyperglycemic hyperosmolar state (HHS) is a condition that results from having an elevated blood glucose level, typically as a result of having uncontrolled diabetes mellitus, which is a condition in which the body cannot regulate the concentration of glucose in the blood. Symptoms of this state can include increased urination, increased thirst, and even loss of consciousness in extreme cases. The diagnosis of HHS relies on observing characteristic laboratory abnormalities. Treatment focuses on providing the patient with intravenous fluids and supplemental insulin.

Patients with diabetes mellitus are prone to having elevated blood glucose levels due to dysfunction of a hormone called insulin, a substance that normally instructs the body to pick up glucose from the blood to store it. Diabetic patients either have a resistance to insulin, as is seen in type 2 diabetes mellitus, or decreased amounts of insulin produced by the pancreas, as seen in type 1. Without the action of insulin, blood glucose levels increase. This eventually results in increased urination, leading to dehydration.

Symptoms experienced by patients who are in a hyperglycemic hyperosmolar state can vary. Typically they have a history of increased urination, increased thirst, and poor appetite. With further increases in blood glucose levels, they could develop confusion, and eventually could lose consciousness. Other possible symptoms include fainting, dizziness, and having a rapid heart rate.

The diagnosis of hyperglycemic hyperosmolar state is typically made by incorporating data collected from the patient's symptoms, a physical examination, and laboratory studies. Patients often appear to be dehydrated on physical exam, and have a dry mouth and dry skin. Laboratory results show a significantly elevated blood glucose level, with values ranging from 600 to 1200 milligrams per deciliter. They also have increased blood sodium levels and increased serum osmolality, which is a value that describes how many substances are dissolved in the blood at a given time. Patients might also have reduced kidney function due to the decreased amount of fluid volume present in the body.

Treatment for hyperglycemic hyperosmolar state focuses on providing the patient with intravenous fluid and giving him or her insulin. Typically patients are immediately given 33.8-101.5 ounces (1-3 liters) of fluids over the course of a couple of hours, and are then supplemented with additional intravenous fluid at a slower rate over a couple of days. An insulin infusion is also immediately given to patients, and they usually receive a big dose of insulin followed by smaller continuous hourly dose of insulin.

Another important aspect of treating hyperglycemic hyperosmolar state is to determine why the elevated blood glucose levels occurred. Many times an infection such as pneumonia or a urinary tract infection could set off the chain of events leading to HHS. In other cases, heart attacks or strokes could lead to developing this condition.