Hyperosmolar Hyperglycemic State

DEFINITION

• Characterized by severe hyperglycemia, hyperosmolality, and dehydration, in the absence of significant ketoacidosis (plasma glucose >600 mg/dL, arterial pH > 7.30, serum bicarbonate >18 meq/L, effective serum osmolality >320 mOsm/kg)[1].
• Initiated by osmotic diuresis due to hyperglycemia. Maintained by insulin levels sufficient to prevent lipolysis and subsequent ketogenesis, but inadequate to appropriately reduce blood glucose levels[6].
• Associated with proinflammatory state, reversed by effective hydration and insulin treatment[1].
• Usually seen in patients with type 2 diabetes (T2DM), in whom it may be the initial presentation. Occurs rarely in children or patients with type 1 diabetes[6][7].