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A metabolic consequence of diabetes mellitus is known as the hyperosmolar hyperglycemic state which is characterized by excessive dehydration, hyperosmolar plasma, and altered consciousness. The most frequent occurrence is in type 2 diabetes, frequently under conditions of physiologic stress. Severe hyperglycemia, plasma hyperosmolality, and the absence of detectable ketosis are indicators of a hyperosmolar hyperglycemic state.
What are Hyperosmolar Hyperglycaemic State Symptoms?
After gathering an understanding of what is Hyperosmolar Hyperglycaemic State, let us have a look at the symptoms:
- HHS typically manifests in older people with type 2 diabetes. HHS has been documented in kids, though, which is in line with the rising rates of type 2 diabetes and obesity in kids and teenagers. The earliest indication of type 2 diabetes may be HHS.
- Patients typically get critically ill very rapidly and require immediate evaluation and treatment.
- HHS typically presents as a severely unwell patient with focal or systemic neurological dysfunction and indications of excessive dehydration upon initial assessment.
- Patients typically experience generalized weakness, leg cramping, or vision impairment as early signs.
- Vomiting and nausea are possible.
- Patients may become bed-bound, hazy, and lethargic as the illness worsens.
- Focal neurological symptoms like hemisensory abnormalities or weakness on one side can appear and are easily mistaken for a stroke.
- Up to 25% of cases involve seizures. Generalized, focal, movement-induced, or myoclonic-jerk type seizures are all possible.
Hyperosmolar Hyperglycemic State Diagnosis
- Blood glucose level
- Serum osmolarity
When a fingerstick specimen is taken during a workup of an altered mental status and shows a noticeably increased glucose level, the hyperosmolar hyperglycemic state is typically immediately assumed. Serum electrolytes, blood urea nitrogen (BUN), creatinine, glucose, ketones, and plasma osmolality should all be measured if they haven’t already been. Ketones in the urine should be checked. Sodium levels in the serum might be low or high depending on volume deficiencies, while serum potassium levels are often normal. Since dilutional hyponatremia from hyperglycemia might occur, measured serum sodium is adjusted by adding 1.6 mEq/L (1.6 mmol/L) for every 100 mg/dL (5.6 mmol/L) increase in serum glucose. The values of BUN and serum creatinine are significantly elevated. Although arterial pH is often greater than 7.3, lactate buildup can occasionally cause a minor metabolic acidosis to occur.
Hyperosmolar Hyperglycemic State Treatment
Dehydration, hyperglycemia, hyperosmolality, electrolyte imbalance, increased ketonaemia, as well as the identification and management of any precipitating events, are all goals of the management of the hyperosmolar hyperglycaemic state.
Two uncommon but potentially fatal consequences may be linked to poor management of plasma sodium concentration and plasma osmolality during treatment (cerebral oedema and osmotic demyelination syndrome).
Other objectives include avoiding additional risks including arterial or venous thrombosis and foot ulcers.
Ways of Prevention
- Diabetes sufferers should be well-informed about managing their illness, especially when unwell.
- It may be possible to identify the issue earlier if medical professionals are aware that this is a possible presentation of diabetes.
- Patients who have had HHS should receive information and additional support in an effort to prevent a repeat of this risky scenario.
