Hyperosmolar hyperglycemic state (HHS)

Hyperosmolar hyperglycemic state (HHS) is a life-threatening hyperglycemic complication of diabetes mellitus (DM), and common reason for admission to the intensive care unit.

The mortality rate is 5% to 20% in HHS. With worse outcomes at extremes of age and with the presence of coma, hypotension and sever comorbidities.

HHS is usually precipitated by inadequate insulin secretion or impaired cation associated with rising glucose levels, and is more commonly seen in patients with who have type 2 diabetes mellitus or no prior history of diabetes mellitus.

Thus, HHS can be defined by the presence of hyperglycemia (serum glucose less than 600 mg/DL) and (hyperosmolality (more than 320 mOsm/L) in the absence of significant ketonemia and academia.

Diabetic ketoacidosis (DKA) is the closely related syndrome defined by the presence of hyperglycemia, ketonemia and acidemia.

Most patients who develop HHS are elderly, with decreased compensatory mechanism to maintain homeostasis in hyperosmolar states.

A major illness that mediates overproduction of glucose secondary to the stress response may contribute to the development of HHS. HHS is primarily a complication of type 2 diabetes but may also occur in type I diabetes.
Hyperosmolar hyperglycemic state (HHS)