Journal of Diabetology

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Opinion Article - Journal of Diabetology (2023) Volume 7, Issue 5

Prognosis and complications of hyperosmolar hyperglycemic state

Sarahaya Dubbs B *


Corresponding Author:
Sarahaya Dubbs B
Department of Emergency Medicine
University of Maryland School of Medicine, Baltimore, USA

Received: 28-Aug-2023, Manuscript No. AADY-23-118322; Editor assigned: 30-Aug-2023, PreQC No. AADY-23-118322(PQ); Reviewed: 13-Sep-2023, QC No. AADY-23-118322; Revised: 15-Sep-2023, Manuscript No. AADY-23-118322(R); Published: 22-Sep-2023, DOI:10.35841/aady-7.5.165

Citation: D B Sarahaya. Prognosis and complications of hyperosmolar hyperglycemic state. J Diabetol. 2023; 7(5):165

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Hyperosmolar Hyperglycemic State, formerly known as Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS), is a severe and life-threatening complication of diabetes mellitus. While it is less frequent than diabetic ketoacidosis (DKA), HYPEROSMOLAR HYPERGLYCEMIC STATE  is associated with significant morbidity and mortality, primarily affecting individuals with type 2 diabetes. This article aims to provide an in-depth exploration of hyperosmolar hyperglycemic state , its epidemiology, pathophysiology, clinical presentation, diagnosis, and management. Hyperosmolar Hyperglycemic State (HYPEROSMOLAR HYPERGLYCEMIC STATE ) is a life-threatening medical emergency characterized by extreme hyperglycemia, dehydration, and high osmolarity. Although less common than diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state  poses significant risks to individuals with diabetes, especially those with type 2 diabetes. This research article provides a comprehensive review of HYPEROSMOLAR HYPERGLYCEMIC STATE , including its epidemiology, pathophysiology, clinical presentation, diagnosis, and management [1].

. A better understanding of hyperosmolar hyperglycaemic state  is crucial for healthcare professionals to improve patient outcomes.


This comprehensive review of hyperosmolar hyperglycaemic state provides insights into its clinical relevance, pathophysiological basis, and the strategies required to manage and mitigate its impact on individuals with diabetes. With ongoing research and advancements in diabetes management, early recognition and prompt intervention can reduce the morbidity and mortality associated with this serious medical condition [2].



Hyperosmolar hyperglycemic state is more common in older individuals with type 2 diabetes, but it can also affect those with type 1 diabetes or previously undiagnosed diabetes. The exact prevalence of hyperosmolar hyperglycemic state  is challenging to determine due to variations in diagnostic criteria and underreporting. However, it is clear that HYPEROSMOLAR HYPERGLYCEMIC STATE  remains a critical concern in diabetes management, often precipitated by factors such as infection, inadequate glycemic control, medication non-compliance, and concomitant illnesses [3].



The pathophysiology of hyperosmolar hyperglycemic state involves a profound state of hyperglycemia, hyperosmolarity, and dehydration. It is characterized by insulin deficiency, typically not as severe as in DKA, and increased counterregulatory hormones. Hyperglycemia results in osmotic diuresis, causing excessive water loss and electrolyte imbalances [4].

. The hyperosmolarity in HYPEROSMOLAR HYPERGLYCEMIC STATE  can lead to severe neurological manifestations, making it distinct from DKA.


Clinical presentation

The clinical presentation of hyperosmolar hyperglycemic state  is often insidious and can include the following features:

Profound hyperglycemia, typically exceeding 600 mg/dL (33.3 mmol/L).

Severe dehydration with signs of hypovolemic shock, such as tachycardia, hypotension, and decreased skin turgor.

Altered mental status, ranging from confusion to coma, which is a hallmark of hyperosmolar hyperglycemic state .

Neurological symptoms, including seizures, focal deficits, and hemiparesis, due to hyperosmolarity.

Laboratory findings may reveal an increased serum osmolarity, high blood glucose levels, and minimal to no ketonemia or ketonuria.


The diagnosis of hyperosmolar hyperglycemic state is primarily clinical, with laboratory confirmation. Essential diagnostic criteria include:

Severe hyperglycemia (often >600 mg/dL or 33.3 mmol/L).

Profound dehydration and clinical signs of hypovolemia.

Altered mental status, ranging from confusion to coma.

Increased serum osmolarity (>320 mOsm/kg).

Laboratory investigations should also include electrolyte assessment, arterial blood gas analysis, and exclusion of other possible causes of hyperglycemia and altered consciousness, such as stroke or sepsis.


The management of hyperosmolar hyperglycemic state  is multifaceted and aims to correct hyperglycemia, dehydration, and electrolyte imbalances while addressing underlying precipitating factors. Key components of hyperosmolar hyperglycemic state  management include:

Aggressive rehydration with isotonic saline to restore vascular volume.

Correction of electrolyte imbalances, including potassium and phosphate replacement.

Gradual reduction of hyperglycemia with intravenous insulin therapy.

Identification and treatment of precipitating factors, such as infections.

Frequent monitoring of blood glucose, electrolytes, and clinical status.

Close supervision in an intensive care setting, especially in severe cases.

Prognosis and complications:

The prognosis of hyperosmolar hyperglycemic state depends on the timely diagnosis and appropriate management of the condition [5].

. Mortality rates are highest in older adults with comorbidities, but with adequate medical attention, most patients can recover. Nevertheless, hyperosmolar hyperglycemic state can lead to complications such as organ failure, thrombosis, and neurological deficits, underscoring the importance of vigilant management.



Hyperosmolar Hyperglycemic State is a severe and life-threatening complication of diabetes that predominantly affects individuals with type 2 diabetes. Understanding its epidemiology, pathophysiology, clinical presentation, diagnosis, and management is essential for healthcare professionals to improve patient outcomes. The prevention of hyperosmolar hyperglycemic state through optimal diabetes care, including glycemic control and patient education, remains a critical goal in reducing its incidence.


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