Hyperosmolar hyperglycemic state natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
OR
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
Natural History, Complications, and Prognosis
Natural History
The natural history of disease details how the disease progresses without treatment. Here are a few template sentences you can use: "The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___. The symptoms of (disease name) typically develop ___ years after exposure to ___. Without treatment, the patient will develop symptoms of ___, which will/ may eventually lead to ___.
- If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
- If left untreated, diabetic ketoacidosis may progress to multi-organ failure and death
- The symptoms of hyperosmolar hyperglycemic state (HHS) usually develop over several days to weeks as compared to diabetic ketoacidosis which presents within hours of inciting event.
- Early in the course of disease HHS usually presents with symptoms of hyperglycemia such as polyuria, polydipsia, and dehydration.
- As HHS progresses, it leads to increase in serum osmolality which can present with neurological manifestations such as altered sensorium, focal signs, confused state or even coma. Neurological symptoms rarely present with an osmolality of less than 320 mOsm/kg.
- The severity of dehydration in HHS is due to insidious onset and longer duration of metabolic decompensation and also due to the reduced fluid intake.
- The increase in plasma osmolality leads to water shifts out of the cells and causes intracellular dehydration and with insulin deficiency, it further exacerbates potassium movement out of the cell.
- The dehydration leads to decrease glomerular filtration rate (GFR) and renal clearance of glucose, which further exacerbates hyperglycemia and ultimately renal failure.
- Hypotension or shock during DKA is nearly always the result of dehydration and hypovolemia.
- Heart failure, myocardial infarction, and arrhythmias are seen commonly in untreated hyperosmolar hyperglycemic state.
Complications
- Complications of hyperosmolar hyperglycemic state (HHS) include:
- Cardiovascular complications
- Acute renal failure
- Thrombotic events
- Infectious complications
- Common complications due to the treatment of hyperosmolar hyperglycemic state (HHS) include:
- Cerebral edema due to aggressive hydration
- Pulmonary edema
- Less common complications due to the treatment of hyperosmolar hyperglycemic state (HHS) include:
- Hypoglycemia
- Hypokalemia
Prognosis
This section should detail the prognosis of the disease, both treated and untreated.
- Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
- Depending on the extent of the [tumor/disease progression/etc.] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
- The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
- [Subtype of disease/malignancy] is associated with the most favorable prognosis.
- The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.