Hyperosmolar hyperosmotic syndrome

Hyperosmolar hyperosmotic syndrome 

Updated: 01/21/2021

© Jun Wang, MD, PhD

General features
  • Life threatening
  • More common in type 2 diabetes
  • Usually associated with concomitant infection, reduced fluid intake
  • Diagnosed based on history, clinical presentation, and typical laboratory findings
Key pathogenesis
  • Hyperglycemia causes osmotic diuresis, then subsequent dehydration
  • Dehydration results in impaired renal function
Clinical presentations
  • Presentations of diabetes
  • Dehydration
  • Impaired renal function
  • Altered mental status
Key Laboratory findings
  • Hyperglycemia
  • Hyperosmolarity
  • Dehydration
  • NO ketoacidosis
Diagnosis
  • Plasma glucose level of 600 mg/dL or greater
  • Effective serum osmolality of 320 mOsm/kg or greater
  • Profound dehydration, up to an average of 9L
  • Serum pH greater than 7.30 (No acidosis)
  • Bicarbonate concentration greater than 15 mEq/L
  • No significant ketosis
  • Alteration in consciousness
Managements
  • Focus on underlying disease
  • Managements for dehydration and altered mental status


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