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
Diabetes mellitus	Hyperglycemia: Fasting blood glucose level: >126 mg/dl Random blood glucose level: >200 mg/dl HbA1C: >6.5 %	Urinanalysis may show: Proteinuria Glucosuria	+ antibodies: (Type 1 diabetes) Anti-glutamic acid decarboxylase Anti-islet cell Anti-insulin		Autonomic and peripheral neuropathy Increased susceptibility to infections	Renal impairment (microalbuminuria leading to renal failure) Decreased visual acuity (diabetic retinopathy)	Central obesity Obesity (BMI >25 kg/m2)	Vascular occlusion secondary to atherosclerosis (Stroke, myocardial infarction) Hypertension (Blood pressure >140/90 mmHg)	Family history of diabetes	Sedentary lifestyle Stress	Polyuria Polydipsia Polyphagia Weight loss	History of gestational diabetes Polycystic ovarian syndrome Acanthosis nigricans
Diabetic ketoacidosis	Blood pH < 7.3	Serum bicarbonate < 18 mEq/L	Anion gap > 10 mEq/L	Increased serum osmolarity
Impaired glucose tolerance	Hyperglycemia: Fasting blood glucose level: 100-125 mg/dl Oral glucose tolerance test: 140-200 mg/dl
stress hyperglycemia

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)		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].