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

Introduction

Hyperosmolar Hyperglycemic State (HHS) is a life-threatening complication of diabetes mellitus, characterized by extreme hyperglycemia, dehydration, and altered consciousness without significant ketoacidosis.

Causes

• Inadequate insulin levels
• Infections (e.g., pneumonia, UTI)
• Acute illnesses such as myocardial infarction or stroke
• Medications like corticosteroids or diuretics

Pathophysiology

HHS results from profound dehydration due to osmotic diuresis caused by sustained hyperglycemia. Unlike diabetic ketoacidosis (DKA), ketogenesis is minimal due to the presence of some residual insulin activity.

Diagnosis

• Blood glucose >600 mg/dL
• Serum osmolality >320 mOsm/kg
• Minimal ketonemia
• Altered mental status

Management

Stabilization and Initial Management

• Fluid Resuscitation: IV normal saline to correct dehydration
• Insulin Therapy: Low-dose insulin infusion to reduce hyperglycemia
• Electrolyte Correction: Monitoring and replacing potassium, phosphate, and magnesium as necessary

Prevention

• Strict glycemic control
• Regular monitoring of blood glucose levels
• Proper management of comorbid conditions

Conclusion

Early recognition and prompt intervention are critical in managing HHS. Adequate hydration, insulin therapy, and electrolyte monitoring are essential components of treatment.