Podcast 791: Hyperglycemic Hyperosmolar State

<p><strong>Contributor: Aaron Lessen, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Hyperglycemic Hyperosmolar State (HHS) is less common than Diabetic Ketoacidosis (DKA) but is associated with a mortality rate up to 10 times greater than that seen in DKA</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Typically seen in elderly patients with severely elevated blood glucose levels (>1000 mg/dL) and an increased plasma osmolality</span></li> <li style="list-style: none; display: inline"> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Unlike in DKA, patients with HHS do not have elevated ketones</span></li> </ul> </li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Treatment of HHS includes insulin administration along with correcting fluid and electrolyte abnormalities</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">When treating HHS, it is important to monitor and follow osmolality regularly because over-rapid correction can result in the development of cerebral edema</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Fayfman M, Pasquel FJ, Umpierrez GE. Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. Med Clin North Am. 2017;101(3):587-606.</span></p> <p><span style="font-weight: 400;">Gosmanov AR, Gosmanova EO, Kitabchi AE. Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. In: Feingold KR, Anawalt B, Boyce A, et al., eds. Endotext. South Dartmouth (MA): MDText.com, Inc. Copyright © 2000-2022, MDText.com, Inc.; 2000.</span></p> <p><span style="font-weight: 400;">Long B, Willis GC, Lentz S, Koyfman A, Gottlieb M. Diagnosis and Management of the Critically Ill Adult Patient with Hyperglycemic Hyperosmolar State. J Emerg Med. 2021;61(4):365-375.</span></p> <p