Hyperosmolar hyperglycemic state (patient information)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

Overview

The hyperosmolar hyperglycemic state is a serious complication of diabetes. It may occur in both type 1 diabetes and type 2 diabetes, but is most common in people with type 2 diabetes. Some triggers, such as infection, trauma, heart attack, surgery or missing doses of insulin may lead to this condition. Usual signs and symptoms of the hyperosmolar hyperglycemic state include weakness, fatigue, lethargy, nausea and vomiting, excessive thirst, even confusion, stupor that may progress to coma. Tests of blood sugar level and plasma osmolality may be helpful for the diagnosis. The goal of treatment of hyperosmolar hyperglycemic state is to correct the high glucose level by giving more insulin and to replace fluid loss through excessive urination and vomiting. Prognosis of the hyperosmolar hyperglycemic state varies, depending on patient's age, treatment and complications.

What are the Symptoms of hyperosmolar hyperglycemic state

The following signs and symptoms are indicative of hyperosmolar hyperglycemic state especially in an elderly diabetic patient:

• Nausea and vomiting
• Excessive thirst
• Dry skin and mouth
• Frequent urination
• Fatigue
• Loss of appetite
• Weakness
• Confusion, stupor that may progress to coma

What Causes Hyperosmolar hyperglycemic state

Sugar which is the main source of energy for cells, needs insulin to enter inside the cells. In hyperosmolar hyperglycemic state (HHS), the patient has a relative insulin deficiency. When the patient lacks enough insulin, sugar will not be able to enter inside the cell. This situation prompts the release of certain hormones that further increase the sugar in the body. The excess sugar also leads to increase urination which causes dehydration and damage to different body organs such as the kidney. This process may be triggered in the presence of any infection, drugs or illness such as heart attack or long-standing kidneyproblems.

Who is at Highest Risk?

Elderly patients with type 2 diabetes who have decreased access to fluids or any condition that limits fluid intake or during an illness such as pneumonia, heart attack, stroke or pregnancy are at highest risk for the hyperosmolar hyperglycemic state. This condition has also been seen in type 1 diabetes, children, and young adults, but less common.

Diagnosis

The hyperosmolar hyperglycemic state can be diagnosed by history taking, physical examination, and simple lab tests.

• Blood sugar level higher than 300 mg/dl.
• High plasma osmolality levels.
• Changes in the mental status of the patient may be noticeable.
• Blood sugar can be checked by simple finger stick sugar testing.

When to Seek Urgent Medical Care?

Seek urgent medical care as soon as possible especially in a diabetic patient, if you experience either of the following symptoms:

• Vomiting or nausea
• Fatigue
• Cramps
• Decreased consciousness or mental stupor

Treatment Options

The treatment goal for hyperosmolar hyperglycemic state is to correct the high blood sugar levels and high plasma osmolality by giving insulin and replacing fluids lost through excessive urination and vomiting.

• Fluid and electrolyte replacement: The patients will receive fluids and electrolytes to replace those that they lost through excessive urination and vomiting. This can help dilute the excess sugar and help keep a normal internal environment to make the body work well.
• Insulin therapy: The purpose of insulin therapy is to control blood sugar levels. Usually, the patients with the hyperosmolar hyperglycemic state will receive insulin therapy through a vein.
• Treatment for the trigger of hyperosmolar hyperglycemic state: The hyperosmolar hyperglycemic state usually has an underlying inciting cause such as heart attack or chest infection etc which needs to be identified and treating accordingly.

Where to find Medical Care for (Disease name)?

Directions to Hospitals Treating hyperosmolar hyperglycemic state

Prevention

Blood sugar control

• Adopt a healthy lifestyle: Make healthy eating and physical activity part of your daily routine. Take oral diabetes medications or insulin under your doctor's direction.
• Learning to self-monitor your blood sugar level. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.

Education about warning signs and symptoms

• Patient as well as family members should have a knowledge of warning signs and symptoms of high blood sugar and dehydration.

What to Expect (Outlook/Prognosis)?

Prognosis of the hyperosmolar hyperglycemic state depends on:

• Whether the patient is diagnosed or treated in time.
• The age of the patient as individual more than 65 years of age have worse outcomes.
• Whether other conditions such as, such as heart attack or renal failure are present.
• The presenting signs and symptoms at the time of hospital presentation such as low blood pressure, shock, unconsciousness.

Possible Complications

• The hyperosmolar hyperglycemic state is a fatal condition if not treated promptly and can lead to multi-organ failure and evetually death.

Sources

http://www.nlm.nih.gov/medlineplus/ency/article/000434.htm