Hyperosmolar Hyperglycemic State

Anda Gonciulea, M.D., Rita Rastogi Kalyani, M.D., M.H.S., Vanessa Walker Harris, M.D.


  • 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