Hyperosmolar hyperglycemic syndrome: A comprehensive review of clinical presentation, diagnosis, and treatment strategies in hyperglycemic crises
DOI:
https://doi.org/10.12775/JEHS.2024.55.014Keywords
hyperglycemic hyperosmolar state, HHS, diabetes mellitus, hyperglycemiaAbstract
Introduction and Purpose Hyperosmolar Hyperglycemic State (HHS), a severe type 2 diabetes complication, presents with profound hyperglycemia, hyperosmolality, and dehydration sans ketosis, posing distinct challenges in diagnosis and treatment compared to diabetic ketoacidosis (DKA). This article aims to enhance medical community awareness by examining HHS features, prevalence, and associated risk factors, contributing to improved clinical management. Emphasizing tailored treatment strategies for dehydration, coexisting illnesses, and metabolic decompensation, it ultimately seeks to enhance outcomes for type 2 diabetes individuals.
Material and methods Conducting a systematic review of medical articles from 1972 to 2023 using PubMed, this study analyzed keywords such as hyperglycemic hyperosmolar state, HHS, diabetes mellitus, hyperglycemia, and dehydration. Inclusion of pertinent articles ensured a comprehensive exploration of Hyperosmolar Hyperglycemic State (HHS) literature during the specified timeframe.
Brief description of the state of knowledge. Hyperosmolar Hyperglycemic Syndrome (HHS) predominantly affects elderly type 2 diabetes individuals, often triggered by infections like pneumonia or urinary tract infections. Clinical presentation includes fatigue, weakness, polydipsia, polyuria, nausea, and altered consciousness. Diagnosis relies on criteria such as elevated blood glucose levels and increased osmolality. HHS management involves a multidisciplinary approach, addressing fluid depletion, compromised cerebral perfusion, and achieving gradual normalization of osmolality and blood glucose levels to prevent complications.
Summary Hyperosmolar Hyperglycemic Syndrome (HHS), a severe metabolic disorder linked to diabetes, extends beyond hyperglycemia, necessitating a comprehensive understanding. This review sheds light on HHS etiology, clinical manifestations, diagnostic criteria, and treatment modalities, emphasizing its critical nature in diabetes care.
References
Pasquel FJ, Umpierrez GE. Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment. Diabetes Care. 2014 Nov;37(11):3124-31. doi: 10.2337/dc14-0984.
Zubkiewicz‐Kucharska A, Chrzanowska J, Noczyńska A. Hyperosmolar hyperglycaemic state (HHS) as the first manifestation of type 2 diabetes in a child. Pediatr Endocrinol Diabetes Metab. 2019;25(2):85‐89. doi: 10.5114/pedm.2019.85819
Röder PV, Wu B, Liu Y, Han W. Pancreatic regulation of glucose homeostasis. Exp Mol Med. 2016 Mar 11;48(3):e219 doi: 10.1038/emm.2016.6
Adeyinka A, Kondamudi NP. Hyperosmolar Hyperglycemic Syndrome. StatPearls Publishing; 2023 Jan. 2023 Aug 12.
American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2010 Jan; 33(Suppl 1): S62–S69. doi: 10.2337/dc10-S062
Mustafa OG, Haq M, Dashora U, Castro E, Dhatariya KK, the Joint British Diabetes Societies (JBDS) for Inpatient Care Group. Management of Hyperosmolar Hyperglycaemic State (HHS) in Adults: An updated guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care Group. Diabetic Medicine 2023 Mar; 40(3): e15005. doi: 10.1111/dme.15005
Wachtel TJ.The diabetic hyperosmolar state. Clin Geriatr Med. 1990 Nov;6(4):797-806.
Berger W. [Diabetic emergencies]. Praxis (Bern 1994). 1997 Feb 18;86(8):308-13.
English P, Williams G. Hyperglycaemic crises and lactic acidosis in diabetes mellitus. Postgrad Med J 2004;80:253–261. doi: 10.1136/pgmj.2002.004291
Bartoli E, Bergamasco L, Castello L, Sainaghi PP. Methods for the quantitative assessment of electrolyte disturbances in hyperglycaemia. Nutr Metab Cardiovasc Dis. 2009;19(1):67‐74. doi: 10.1016/j.numecd.2008.10.005
Zeitler P, Haqq A, Rosenbloom A, Glaser N. Hyperglycemic hyperosmolar syndrome in children: pathophysiological considerations and suggested guidelines for treatment. J Pediatr. 2011;158(1):9‐14. doi: 10.1016/j.jpeds.2010.09.048
Fadini GP, De Kreutzenberg SV, Rigato M, Brocco S, Marchesan M, Tiengo A, Avogaro A. Characteristics and outcomes of the hyperglycemic hyperosmolar non-ketotic syndrome in a cohort of 51 consecutive cases at a single center. Diabetes Res Clin Pract. 2011;94:172–179. doi: 10.1016/j.diabres.2011.06.018.
Dhatariya K K, Vellanki P. Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Advances in the Management of Hyperglycemic Crises (UK Versus USA). Curr Diab Rep. 2017; 17(5): 33., doi: 10.1007/s11892-017-0857-4
Gershkovich B, English SW, Doyle MA, Menon K, McIntyre L. Choice of crystalloid fluid in the treatment of hyperglycemic emergencies: a systematic review protocol. Syst Rev. 2019;8(1):228. doi: 10.1186/s13643-019-1130-5
Hockaday TD, Alberti KG. Diabetic coma. Clin Endocrinol Metab. 1972 Nov;1(3):751-88.
Katz MA. Hyperglycemia‐induced hyponatremia ‐ calculation of expected serum sodium depression. N Engl J Med. 1973;16(289):843‐844.
Bhave G, Neilson EG. Volume depletion versus dehydration: how understanding the difference can guide therapy. Am J Kidney Dis. 2011;58(2):302‐309.
Scott A, on behalf of the Joint British Diabetes Societies (JBDS) for Inpatient Care Management of hyperosmolar hyperglycaemic state in adults with diabetes. Diabetic Med. 2015;32:714–724. doi: 10.1111/dme.12757.
Zahran NA1, Jadidi S. Pediatric Hyperglycemic Hyperosmolar Syndrome: A Comprehensive Approach to Diagnosis, Management, and Complications Utilizing Novel Summarizing Acronyms. Children (Basel). 2023 Oct 31;10(11):1773. doi: 10.3390/children10111773.
Carr ME. Diabetes mellitus: a hypercoagulable state. J Diabetes Complicat. 2001;15(1):44‐54.
Petrauskiene V, Falk M, Waernbaum I, Norberg M, Eriksson JW. The risk of venous thromboembolism is markedly elevated in patients with diabetes. Diabetologia. 2005;48(5):1017‐1021. doi: 10.1007/s00125-005-1715-5
Wordsworth G, Robinson AH, Ward A, Atkin M. HHS—full or prophylactic anticoagulation? British Journal of Diabetes. 2014;14(2):64‐66.
Kitabchi AE, Umpierrez GE, Murphy MB, et al. Management of hyperglycemic crises in patients with diabetes. Diabetes Care 2001. Jan;24(1):131-53. doi: 10.2337/diacare.24.1.131.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Dominika Orłowska, Wojciech Kapłan, Jan Ostański, Karolina Zalewa, Lidia Bartoszek, Rafał Świdziński, Bartosz Skorupski, Jakub Lipiec, Monika Rogowska, Joanna Olszak
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 797
Number of citations: 0
