Hyperosmolar Hyperglycemic State: Symptoms, Causes, Treatment

It usually affects people with type 2 diabetes and may be its first presentation. It differs from ketoacidosis, although overlap occurs; absent ketones do not mean safety.

Related reading: Type 2 diabetes and follow-up.

Thirst and frequent urination may progress over days to weakness, dehydration and confusion. Drowsiness, seizures or reduced consciousness can occur; coma is not required for diagnosis.

Infection, inadequate fluid intake, interrupted treatment, acute illness or glucose-raising medicines may trigger it. Urinary water and electrolyte losses worsen dehydration.

Older age, difficulty accessing fluids or treatment and acute illness increase risk. HHS can occur before diabetes has been diagnosed, so new symptoms must not be ignored.

Hospital tests assess glucose, osmolality, electrolytes, kidney function, ketones, acidity and the precipitating cause. A home glucose reading alone cannot distinguish crisis type.

Care involves intravenous fluids, close monitoring, electrolyte management and protocol-guided insulin when appropriate. Controlled correction helps avoid injury from rapid physiological shifts.

Shock, kidney injury, clots, electrolyte disturbances or altered consciousness may occur. Discharge requires a clear prevention and follow-up plan.

Follow individualized sick-day guidance and monitor glucose and fluid intake. Seek early help with infection or inability to drink; do not stop diabetes treatment without advice.