Hyperosmolar Hyperglycemic State (HHS): Causes, Pathophysiology, Diagnosis, and Management

Hyperosmolar Hyperglycemic State (HHS) is a life-threatening complication of diabetes mellitus, predominantly affecting type 2 diabetics. It is characterized by extreme hyperglycemia, severe dehydration, altered mental status, and significant electrolyte imbalances.

Causes

• Poor diabetes management
• Infections (e.g., pneumonia, urinary tract infections)
• Medications (e.g., corticosteroids, diuretics)
• Underlying medical conditions (e.g., renal insufficiency, cardiovascular disease)

Pathophysiology

HHS develops due to a significant elevation in plasma glucose levels (>600 mg/dL), leading to osmotic diuresis and subsequent severe dehydration. Unlike diabetic ketoacidosis (DKA), there is minimal ketogenesis due to the presence of residual insulin activity, preventing excessive lipolysis.

Diagnosis

• Plasma glucose >600 mg/dL
• Serum osmolality >320 mOsm/kg
• Severe dehydration with altered mental status
• Absence or minimal ketonemia

Management

Management of HHS requires prompt medical intervention, including:

• Aggressive fluid replacement to correct dehydration
• Insulin therapy to gradually reduce blood glucose levels
• Electrolyte monitoring and correction
• Identification and treatment of underlying causes

Conclusion

Hyperosmolar Hyperglycemic State is a serious metabolic complication that necessitates rapid diagnosis and appropriate management to prevent mortality. Patients with diabetes should adhere to treatment regimens and seek medical attention promptly if symptoms arise.