Hyperglycaemic hyperosmolar state
This common problem is badly managed and on the rise
The current worldwide epidemic of type 2 diabetes has been accompanied by a similarly drastic increase in obesity. Both are caused by changes in diet and an increasingly sedentary lifestyle.
Diabetic ketoacidosis and hyperosmolar hyperglycaemic state (HHS) are two extremes in the spectrum of marked decompensated diabetes and are important causes of morbidity and mortality among patients with diabetes. How can you recognise HHS and promptly initiate the correct management?
HHS is used to describe the extreme metabolic derangement characterised by severe hyperglycaemia (high concentrations of glucose in the blood) and serum hyperosmolarity (high osmotic concentration), without evidence of substantial ketosis.
HHS has replaced the term “hyperosmolar non-ketotic coma” (HONK) to acknowledge that the hyperglycaemic hyperosmolar state may involve a mild to moderate degree of clinical ketosis, and changes in consciousness may present without coma.1 Less than 20% of patients are comatose, and these patients represent the most severe end