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Hyperosmolar Hyperglycemic State

 Syn. HHS , hyperosmotic hyperglycemic nonketotic state , HHNK

Signs & Symptoms

 Noncompliance insulin treatment
Ref: Uptodate [ Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis]
Polyuria
Note: note to The earliest symptoms of marked hyperglycemia are polyuria, polydipsia, and weight loss,due to Marked hyperglycemia
Ref: Uptodate [ Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis] Harrison [ 3117] Cecil [ 669] Epocrates [ https://www.epocrates.com/online/diseases/1011/hyperosmolar-hyperglycemic-state]
Second-generation atypical antipsychotic agents
Note: Drugs that are Predisposing or precipitating factors for HHS
Ref: Uptodate [ Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis]
Weight loss
Note: note to The earliest symptoms of marked hyperglycemia are polyuria, polydipsia, and weight loss,due to marked hyperglycemia
Ref: Uptodate [ Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis] Harrison [ 3117] Epocrates [ https://www.epocrates.com/online/diseases/1011/hyperosmolar-hyperglycemic-state]

Physical Examination

 Altered mental status #criteria
Note: Coma in later stage
Ref: Uptodate [ Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis] Harrison [ 3117] Cecil [ 670] Epocrates [ https://www.epocrates.com/online/diseases/1011/hyperosmolar-hyperglycemic-state]
Coma #criteria
Note: Coma in later stage
Ref: Uptodate [ Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis] Harrison [ 3117] Cecil [ 670] Epocrates [ https://www.epocrates.com/online/diseases/1011/hyperosmolar-hyperglycemic-state]
Low jugular venous pressure
Ref: Uptodate [ Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis] Harrison [ 3117]

Lab / Serology

 Acute elevation in the BUN and serum creatinine concentration
Note: due to Hypovolemia
Ref: Uptodate [ Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis] Harrison [ 3117] Cecil [ 669]
Leukocytosis
Ref: Uptodate [ Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis]
positive Serum keton Nitroprusside reaction (negative symptom)
Ref: Uptodate [ Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis]

Imagin Study

 Intestinal obstruction
Ref: Uptodate [ Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis] Harrison [ 3117] Cecil [ 670]
Obtundation #criteria
Note: Coma in later stage
Ref: Uptodate [ Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis] Harrison [ 3117] Cecil [ 670]

Complication

 Pseudohyperchloremia
Note: due to Hyperlipidemia in uncontrolled diabetic patient
Ref: Uptodate [ Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis]
Pseudohyponatremia
Note: due to Hyperlipidemia in uncontrolled diabetic patient
Ref: Uptodate [ Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis]

Risk Factors

Cause

Other