Hyperosmolar hyperglycemic state (hhs)

[Dave Paprocki]

Hyperosmolar hyperglycemic state is a complication of diabetes mellitus that most often occurs in type 2 diabetes.

Symptoms of hyperosmolar hyperglycemic state include extreme dehydration and confusion.
Hyperosmolar hyperglycemic state is diagnosed by blood tests that show very high levels of glucose and very concentrated blood.
Treatment is intravenous fluids and insulin.
Complications include coma, seizures, and death.

(See also Diabetes Mellitus.)
There are two types of diabetes mellitus, type 1 and type 2. In type 1 diabetes, the body produces almost no insulin , a hormone produced by the pancreas that helps sugar (glucose) move from the blood into the cells. In type 2 diabetes, the body produces insulin , but cells fail to respond normally to the insulin . In both types of diabetes, the amount of sugar (glucose) in the blood is elevated.
If people with type 1 diabetes receive no insulin , or they need more insulin because of an illness, fat cells begin breaking down to provide energy. Fat cells that break down produce substances called ketones. Ketones provide some energy to cells but also make the blood too acidic (ketoacidosis). Diabetic ketoacidosis is a dangerous, sometimes life-threatening, disorder.
Because people with type 2 diabetes produce some insulin , ketoacidosis does not usually develop even when type 2 diabetes is untreated for a long time. However, with hyperosmolar hyperglycemic state, the blood glucose levels can become extremely high (even exceeding 1,000 milligrams per deciliter [mg/dL], or 55.5 millimoles per liter [mmol/L] of blood). Such very high blood glucose levels cause the person to pass large amounts of urine, which eventually causes severe dehydration and makes the person