The hyperosmolar hyperglycemic state (HHS) is characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis. The exact incidence of HHS is not known, but it is estimated to account for <1% of hospital admissions in patients with diabetes. The person with HHS is often elderly, frequently with multiple co-morbidities but always very sick. But recently, the incidence among children and young adults has been increased.
Hyperglycemia develops because of an increased gluconeogenesis and accelerated conversion of glycogen to glucose (glycogenolysis) and by inadequate use of glucose by peripheral tissues, primarily muscle.
Although there are multiple precipitating causes, underlying infections are the most common. Other causes include certain medications, nonadherence to therapy, undiagnosed diabetes mellitus, substance abuse, and coexisting disease.
The high sugar beverages consumed by type 1 diabetes patients secondary to polydipsia could result in high blood glucose and serum osmolality, provoking an HHS, despite type 1 diabetes pathophysiology.
Hyperglycemic hyperosmolar
