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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