Hyperglycemic Hyperosmolar Syndrome

Submitted by Thiruvelan on Wed, 10/23/2013

Hyperglycemic hyperosmolar syndrome (HHS) is a type2 diabetes complication involving extremely high blood sugar levels without ketones. 

What is hyperglycemic hyperosmolar syndrome?

Diabetic HHS is a condition of severely high blood sugar, extreme lack of water (dehydration), and decreased consciousness. Generally, there may be ketone’s build-up in the body often mild. HHS is usually developed among type2 diabetes and occasionally among undiagnosed patients. 

Alternative names are hyperglycemic-hyperosmolar coma, nonketotic-hyperglycemic hyperosmolar coma (NKHHC), or hyperosmolar-nonketotic coma (HONK).

HHS causes

Most often, this condition has brought on by 

  • Poorly managed diabetes,
  • Infection,
  • Severe illness (such as infection, heart attack or stroke, and resent surgery),
  • Poor kidney function,
  • Older age,
  • Medication increased fluid loss (such as diuretic).

The kidney try removing this high blood glucose through urine, if you do not drink enough liquid or taking sugar-rich fluid makes it difficult for the kidney to remove excess glucose. 

HHS symptoms

HHS symptoms are coma, confusion, convulsions, fever, increased thirst, increased urination, lethargy, nausea, and fatigue. The condition worsens over time with severe symptoms such as dysfunctional movement, loss of feeling/function of muscles, and impaired speech.

HHS diagnosis and tests

HHS diagnosis is by examining the symptoms such as extreme dehydration, high fever, increased heart rate, and drop in systolic BP. 

Tests for diagnosis of HHS are blood osmolarity (concentration), BUN & creatinine levels, blood sodium level, ketone test, and blood-glucose test. Other evaluation tests include blood cultures, chest x-ray, electrocardiogram (ECG), and urinalysis.

HHS treatment

HHS treatment goal is to correct dehydration, normalize BP, improve urine output and boost circulation. Increase potassium rich fluid intake, if it is impossible orally, then give through intravenously. Normalize the blood-glucose level with insulin treatment. 

If untreated can lead to various complications such as acute circulatory collapse (shock), blood clot, brain swelling or cerebral edema, and lactic acidosis (blood becomes acidic).

HHS prevention

Prevention HHS by proper type2 diabetes management and learn to recognize the early symptoms of dehydration & infection.