Hyperglycemic hyperosmolar state (HHS) is caused by uncontrolled diabetes, resulting in high blood glucose levels, dehydration, and symptoms such as increased urination and thirst. Diagnosis is based on lab abnormalities, and treatment involves intravenous fluids and insulin. HHS can be triggered by infections or other medical conditions.
A hyperglycemic hyperosmolar state (HHS) is a condition that results from having a high blood glucose level, typically due to uncontrolled diabetes mellitus, which is a condition in which the body cannot regulate blood glucose concentration. Symptoms of this state can include increased urination, increased thirst and even loss of consciousness in extreme cases. The diagnosis of HHS is based on the observation of characteristic laboratory abnormalities. Treatment focuses on providing the patient with intravenous fluids and supplemental insulin.
Patients with diabetes mellitus are prone to have high blood glucose levels due to dysfunction of a hormone called insulin, a substance that normally instructs the body to take glucose from the blood for storage. Diabetic patients have insulin resistance, as seen in type 2 diabetes mellitus, or a decrease in the amount of insulin produced by the pancreas, as seen in type 1 diabetes mellitus. Without the action of insulin, glucose levels in the blood they increase. This eventually results in increased urination, which leads to dehydration.
The symptoms experienced by patients who are in a hyperglycemic hyperosmolar state can vary. They typically have a history of increased urination, increased thirst, and poor appetite. With further increases in blood glucose levels, they may develop confusion and eventually lose consciousness. Other possible symptoms include fainting, dizziness, and a rapid heartbeat.
The diagnosis of hyperglycemic hyperosmolar state is typically made by incorporating data gleaned from the patient’s symptoms, a physical exam, and laboratory studies. Patients often appear dehydrated on physical examination and have dry mouth and dry skin. Lab results show a significantly elevated blood glucose level, with values ranging from 600 to 1200 milligrams per deciliter. They also have increased blood sodium levels and increased serum osmolality, which is a value that describes how many substances are dissolved in the blood at any given time. Patients may also have decreased kidney function due to the reduced amount of fluid volume in the body.
Treatment for the hyperglycemic hyperosmolar state focuses on giving the patient intravenous fluids and administering insulin. Typically patients are given 33.8-101.5 ounces (1-3 liters) of fluid immediately over the course of a couple of hours, and then supplemented with additional intravenous fluid at a slower pace over a couple of days. Patients are also given an insulin infusion immediately and usually receive a large dose of insulin followed by a smaller continuous hourly dose of insulin.
Another important aspect of treating the hyperglycemic hyperosmolar state is to determine why high blood glucose levels have occurred. Many times an infection such as pneumonia or a urinary tract infection could set off the chain of events leading to HHS. In other cases, heart attacks or strokes could lead to the development of this condition.
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