endocrine and metabolic disorders
Hyperosmolar Hyperglycemic State (HHS)
Key Points
Hyperosmolar hyperglycemic state (HHS) is a metabolic complication of diabetes mellitus characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. HHS can occur if infections, nonadherence, and certain medications trigger marked glucose elevation, dehydration, and altered consciousness in patients with type 2 diabetes. Patients have adequateinsulinpresent to prevent ketoacidosis. The fluid deficit can exceed 10 L; treatment is 0.9% saline solution IV plusinsulininfusion. Target plasma glucose in acute treatment is between 250 and 300 mg/dL (13.9 to 16.7 mmol/L). Give potassium replacement depending on serum potassium levels. 