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

Hyperosmolar Hyperglycemic State (HHS) is a severe complication of diabetes mellitus, characterized by extreme hyperglycemia, dehydration, and altered mental status.

Causes

• Poorly controlled diabetes
• Infection (e.g., pneumonia, urinary tract infection)
• Medications (e.g., corticosteroids, diuretics)
• Recent surgery or trauma
• Non-compliance with diabetes treatment

Pathophysiology

HHS is caused by insulin deficiency combined with a significant increase in counter-regulatory hormones, leading to marked hyperglycemia and osmotic diuresis.

Diagnosis

Laboratory findings in HHS include:

• Blood glucose > 600 mg/dL
• Serum osmolality > 320 mOsm/kg
• Severe dehydration and electrolyte imbalance
• Minimal to absent ketonemia

Management

Treatment includes aggressive IV fluid replacement, electrolyte correction, and insulin therapy.

Long-term Management and Prevention

• Patient education on diabetes management
• Regular monitoring of blood glucose levels
• Addressing underlying causes such as infections or medication issues
• Proper medication adherence and lifestyle modifications