Hyperosmolar hyperglycemic state differential diagnosis

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

Overview

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Differentiating Hyperosmolar hyperglycemic state from other Diseases

Hyperosmolar hyperglycemic state must be differentiated from other diseases that cause hyperglycemia, hyperosmolarity, and altered state of conciousness.

• Other conditions causing hyperglycemia
  • Diabetes mellitus
  • Diabetic ketoacidosis
  • Impaired glucose tolerance
  • Stress hyperglycemia
• Other conditions causing hyperosmolarity
  • Central diabetes inspidus
  • Primary hyperaldosteronism
  • Secondary hyperaldosteronism
• Other conditions causing altered state of conciousness
  • CNS infections
  • Hypoglycemia
  • Severe dehydration
  • Stroke
  • Hyperammonemia
  • Uremia

Diseases	Laboratory Findings				Physical Examination				History and Symptoms				Other Findings
	Lab Test 1	Lab Test 2	Lab Test 3	Lab Test 4	Physical Finding 1	Physical Finding 2	Physical Finding 3	Physical Finding 4	Finding 1	Finding 2	Finding 3	Finding 4
Differential Diagnosis 1			+
Differential Diagnosis 2	↑			-
Differential Diagnosis 3		↓
Differential Diagnosis 4
Differential Diagnosis 5

Characteristic Common to Hyperosmolar hyperglycemic state	Condition	History Findings	Clinical Features	Lab abnormalities
Hyperglycemia	Diabetes mellitus	Family history of diabetes Obesity (BMI >25 kg/m2) Stress Sedentary lifestyle History of gestational diabetes Polycystic ovarian syndrome Acanthosis nigricans Hypertension (Blood pressure >140/90 mmHg)	Polyuria Polydipsia Polyphagia Weight loss Central obesity Autonomic and peripheral neuropathy Vascular occlusion secondary to atherosclerosis (Stroke, myocardial infarction) Renal impairment (microalbuminuria leading to renal failure) Decreased visual acuity (diabetic retinopathy) Increased susceptibility to infections Charcot's joints	Hyperglycemia: Fasting blood glucose level: >126 mg/dl Random blood glucose level: >200 mg/dl HbA1C: >6.5 % Urinanalysis may show: Proteinuria Glucosuria Positive antibodies:(Type 1 diabetes) Anti-glutamic acid decarboxylase Anti-islet cell Anti-insulin
	Diabetic ketoacidosis	Younger age with type 1 diabetes mellitus Undiagnosed type 1 diabetes mellitus Prolonged hyperglycemia	May have all clinical features of diabetes mellitus plus: Hypotension Dehydration Tachycardia	Blood pH < 7.3 Serum bicarbonate < 18 mEq/L Anion gap > 10 mEq/L Increased serum osmolarity
	Impaired glucose tolerance	Family history of diabetes Obesity (BMI >25 kg/m2) Stress Sedentary lifestyle History of gestational diabetes Acanthosis nigricans	May have all clinical features of diabetes mellitus	Hyperglycemia: Fasting blood glucose level: 100-125 mg/dl Oral glucose tolerance test: 140-200 mg/dl
Hyperosmolarity	Central diabetes inspidus
	Hyperaldosteronism
Altered state of conciousness	CNS infections
	Hypoglycemia
	Stroke
	Uremia

Use if the above table can not be made

Differential Diagnosis	Similar Features	Differentiating Features
Differential 1	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 2	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 3	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 4	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 5	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].