Hyperosmolar Hyperglycemic State (HHS)

Overview

• HHS: An acute, life-threatening complication of diabetes mellitus.
• Develops slower than Diabetic Ketoacidosis (DKA), over several days.
• Higher mortality rate compared to DKA.

Causes

• Triggered by additional physiological stress:
  • Infections
  • Other illnesses
  • Inadequate diabetic treatment
  • Certain drugs
• Caused by a rise in counter-regulatory hormones:
  • Stimulate production and release of glucose into blood.
  • Leads to glucose overflow into urine, causing water and electrolyte loss.

Differences from DKA

• Major difference: Absence of acidosis in HHS.
  • Insulin levels in HHS are sufficient to suppress lipolysis and ketogenesis.
• More common in type 2 diabetes:
  • Type 2 diabetics produce insulin but cells do not respond to it, cannot use glucose effectively.

Symptoms

• Lack of acidosis symptoms means HHS may go unnoticed until high blood glucose levels occur.
• Severe dehydration:
  • Increases solute concentration in blood, raising osmolarity.
  • Hyperosmotic blood plasma drives water out of tissues, causing cellular dysfunction.
• Primary symptom:
  • Altered consciousness due to brain tissue dehydration (ranging from confusion to coma).

Emergency Treatment

• Intravenous fluids
• Insulin
• Potassium
• Similar treatment approach to DKA.