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Hyperosmolar Hyperglycemic State

Anda Gonciulea, M.D., Rita Rastogi Kalyani, M.D., M.H.S., Vanessa Walker Harris, M.D.
Hyperosmolar Hyperglycemic State is a topic covered in the Johns Hopkins Diabetes Guide.

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  • 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].

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Last updated: June 4, 2019


Gonciulea, Anda, et al. "Hyperosmolar Hyperglycemic State." Johns Hopkins Diabetes Guide, 2019. Johns Hopkins Guide, www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/547065/all/Hyperosmolar_Hyperglycemic_State.
Gonciulea , Rastogi Kalyani R, Harris V. Hyperosmolar Hyperglycemic State. Johns Hopkins Diabetes Guide. 2019. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/547065/all/Hyperosmolar_Hyperglycemic_State. Accessed August 21, 2019.
Gonciulea, ., Rastogi Kalyani, R., & Harris, V. (2019). Hyperosmolar Hyperglycemic State. In Johns Hopkins Diabetes Guide. Available from https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/547065/all/Hyperosmolar_Hyperglycemic_State
Gonciulea , Rastogi Kalyani R, Harris V. Hyperosmolar Hyperglycemic State [Internet]. In: Johns Hopkins Diabetes Guide. ; 2019. [cited 2019 August 21]. Available from: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/547065/all/Hyperosmolar_Hyperglycemic_State.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hyperosmolar Hyperglycemic State ID - 547065 A1 - Gonciulea, Anda,M.D. AU - Rastogi Kalyani,Rita,M.D., M.H.S. AU - Harris,Vanessa Walker,M.D. Y1 - 2019/06/04/ BT - Johns Hopkins Diabetes Guide UR - https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/547065/all/Hyperosmolar_Hyperglycemic_State DB - Johns Hopkins Guide DP - Unbound Medicine ER -