Hyperosmolar hyperglycemic state laboratory findings

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

Overview

Laboratory findings consistent with the diagnosis of hyperosmolar hyperglycemic state (HHS) include plasma glucose > 600 mg/dl, serum osmolarity > 320 mOsm/kg, blood pH > 7.3, serum bicarbonate > 18 mEq/L and negative or trace positive urine or serum ketones.

Laboratory Findings

The following lab abnormalities may be found in hyperosmolar hyperglycemic state (HHS):

LAB	FORMULA/ VARIABLE	NORMAL VALUE	VALUE IN HHS
Plasma glucose (mg/dL)	N/A	< 200 mg/dl	> 600 mg/dl
Arterial ph	Blood pH	7.35-7.45	> 7.30
Anion gap	(Na+) – (Cl– + HCO3–)	7 to 13 (mEq/L)	Variable
Serum osmolality	2(Na + K) + (glucose/18) + (blood urea nitrogen/2.8)	285 to 295 mOsm/kg (285 to 295 mmol/kg) of water	Increased (> 320mOsm/kg)
Plasma ketones			Trace or negative
Urine ketones			Trace or negative
Serum Bicarbonate		23 - 29 mEq/L	> 18 mEq/L
Blood urea nitrogen, creatinine levels	N/A	7-20 mg/dl 0.8-1.2mg/dl	Increased (Dehydration and decreased renal perfusion)
Complete blood count (with differential)	N/A		Increased