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. 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. We searched for relevant articles on the topic in the PubMed database. Common Mesh terms were used: Hyperosmolar hyperglycemic state, emergency management, and complications. 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%.
1. Pasquel FJ, Tsegka K, Wang H, Cardona S, Galindo RJ, Fayfman M, et al. Clinical outcomes in patients with isolated or combined diabetic ketoacidosis and hyperosmolar hyperglycemic state: a retrospective, hospital-based cohort study. Diabetes Care. 2020;43(2):349-57.
2. Tittel SR, Sondern KM, Weyer M, Poeplau T, Sauer BM, Schebek M, et al. Multicentre analysis of hyperglycaemic hyperosmolar state and diabetic ketoacidosis in type 1 and type 2 diabetes. Acta Diabetol. 2020;57(10):1245.
3. Kitabchi AE, Nyenwe EA. Hyperglycemic crises in diabetes mellitus: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Endocrinol Metab Clin. 2006;35(4):725-51.
4. Lenahan CM, Holloway B. Differentiating between DKA and HHS. J Emerg Nurs. 2015;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;37(11):3124-31.
6. Rosival V. Mortality in Hyperglycemic Crisis. J Emerg Med. 2014;47(6):e158-9.
7. Magee MF, Bhatt BA. Management of decompensated diabetes: diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Crit Care Clin. 2001;17(1):75-106.
8. Maletkovic J, Drexler A. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Endocrinol Metab Clin. 2013;42(4):677-95.
9. Van Ness-Otunnu R, Hack JB. Hyperglycemic crisis. J Emerg Med. 2013;45(5):797-805.
10. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32(7):1335-43.
11. De Beer K, Michael S, Thacker M, Wynne E, Pattni C, Gomm M, et al. Diabetic ketoacidosis and hyperglycaemic hyperosmolar syndrome–clinical guidelines. Nurs Crit Care. 2008;13(1):5-11.
12. French EK, Donihi AC, Korytkowski MT. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. BMJ. 2019;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). Curr Diab Rep. 2017;17(5):33.
14. Kisiel M, Marsons L. Recognizing and responding to hyperglycaemic emergencies. Br J Nurs. 2009;18(18):1094-8.
15. Fayfman M, Pasquel FJ, Umpierrez GE. Management of hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Med Clin. 2017;101(3):587-606.
16. Umpierrez G, Korytkowski M. Diabetic emergencies—ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol. 2016;12(4):222.