Archive \ Volume.12 2021 Issue 1

Hyperosmolar hyperglycemic state management in the emergency department

Mohammed A. Alghamdi , Anwar M. Alzahrani , Hajer A. Alshams , Maqdad H. Al-Saif , Ahlam M. Moafa , Mashael M. Alenzi , Lamees E. Seadawi , Ahmed K. A. Ali , Nawaf S. Al-Hufayyan , Mohammed F. Mujallid
Abstract

Background: Hyperosmolar hyperglycemic state is an emergency condition characterized by a significant elevation in blood glucose and serum osmolality level with altered sensorium in the absence of significant ketoacidosis. It is commonly found in the elderly population with poorly controlled type 2 diabetes, but it can also be found in children and adolescents. Early recognition is crucial to establish the precipitating factor and to start proper management immediately. Objective: This literature review aims to provide an overview and pathogenesis of hyperosmolar hyperglycemic state and address the necessity of early recognition by the emergency physician and immediate management approach. Methodology: We searched for relevant articles on the topic in the PubMed database. Common Mesh terms were used: Hyperosmolar hyperglycemic state, emergency management, and complications. Conclusion: The backbone treatment restores the large water deficit and correct electrolyte imbalance induced by severe dehydration. Early identifying the precipitating factor is essential, but not to delay in management. Further instructions must be provided to avoid further attack as HHS has a high mortality rate that reaches 40%.



How to cite:
Vancouver
Alghamdi M A, Alzahrani A M, Alshams H A, Al-Saif M H, Moafa A M, Alenzi M M, et al. Hyperosmolar hyperglycemic state management in the emergency department. Arch. Pharm. Pract. 2021;12(1):37-40. https://doi.org/10.51847/8gxTO9C75T
APA
Alghamdi, M. A., Alzahrani, A. M., Alshams, H. A., Al-Saif, M. H., Moafa, A. M., Alenzi, M. M., & et al (2021). Hyperosmolar hyperglycemic state management in the emergency department. Archives Of Pharmacy Practice, 12(1),37-40. https://doi.org/10.51847/8gxTO9C75T

Download Citation
References
  1. Pasquel FJ, Tsegka K, Wang H, Cardona S, Galindo RJ, Fayfman M, Davis G, Vellanki P, Migdal A, Gujral U, Narayan KV. Clinical outcomes in patients with isolated or combined diabetic ketoacidosis and hyperosmolar hyperglycemic state: a retrospective, hospital-based cohort study. Diabetes Care. 2020 Feb 1;43(2):349-57.

  2. Tittel SR, Sondern KM, Weyer M, Poeplau T, Sauer BM, Schebek M, Ludwig KH, Hammer F, Fröhlich-Reiterer E, Holl RW, DPV Initiative. Multicentre analysis of hyperglycaemic hyperosmolar state and diabetic ketoacidosis in type 1 and type 2 diabetes. Acta diabetologica. 2020;57(10):1245.

  3. Kitabchi AE, Nyenwe EA. Hyperglycemic crises in diabetes mellitus: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Endocrinology and Metabolism Clinics. 2006 Dec 1;35(4):725-51.

  4. Lenahan CM, Holloway B. Differentiating between DKA and HHS. Journal of Emergency Nursing. 2015 May 1;41(3):201-7.

  5. Pasquel FJ, Umpierrez GE. Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment. Diabetes care. 2014 Nov 1;37(11):3124-31.

  6. Rosival V. Mortality in Hyperglycemic Crisis. Journal of Emergency Medicine. 2014 Dec 1;47(6):e158-9.

  7. Magee MF, Bhatt BA. Management of decompensated diabetes: diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Critical care clinics. 2001 Jan 1;17(1):75-106.

  8. Maletkovic J, Drexler A. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Endocrinology and Metabolism Clinics. 2013 Dec 1;42(4):677-95.

  9. Van Ness-Otunnu R, Hack JB. Hyperglycemic crisis. The Journal of Emergency Medicine. 2013 Nov 1;45(5):797-805.

  10. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes care. 2009 Jul 1;32(7):1335-43.

  11. De Beer K, Michael S, Thacker M, Wynne E, Pattni C, Gomm M, Ball C, Walsh D, Thomlinson A, Ullah K. Diabetic ketoacidosis and hyperglycaemic hyperosmolar syndrome–clinical guidelines. Nursing in critical care. 2008 Jan;13(1):5-

  12. French EK, Donihi AC, Korytkowski MT. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. Bmj. 2019 May 29;365.

  13. Dhatariya KK, Vellanki P. Treatment of diabetic ketoacidosis (DKA)/hyperglycemic hyperosmolar state (HHS): novel advances in the management of hyperglycemic crises (UK versus USA). Current Diabetes Reports. 2017 May 1;17(5):33.

  14. Kisiel M, Marsons L. Recognizing and responding to hyperglycaemic emergencies. British Journal of Nursing. 2009 Oct 8;18(18):1094-8.

  15. Fayfman M, Pasquel FJ, Umpierrez GE. Management of hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Medical Clinics. 2017 May 1;101(3):587-606.

  16. Umpierrez G, Korytkowski M. Diabetic emergencies—ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nature Reviews Endocrinology. 2016 Apr;12(4):222.