Hyperosmolar Hyperglycemic State 

Reviewed By: Dr. Damanjit Duggal, MD, MBBS December 15, 2021

Last updated on January 31st, 2022

Many people ask what does hhs mean? This article will tell you in-depth about it, so read on. A hyperglycemic hyperosmolar state (HHS) results from high blood sugar, usually due to uncontrolled diabetes mellitus, which prevents the body from regulating the concentration of glucose in the blood. Symptoms of Hyperosmolar Hyperglycemic State condition can include increased urination, increased thirst, and even loss of consciousness in extreme cases. The diagnosis of HHS is based on the observation of characteristic laboratory abnormalities. Treatment consists mainly of giving the patient intravenous fluids and additional insulin. Read this article to know about the causes and prevention of Hyperglycemic Hyperosmolar State.

Patients with diabetes mellitus tend to have high blood sugar levels due to the malfunction of a hormone called insulin, a substance that generally tells the body to take glucose from the blood for storage. Diabetic patients either have insulin resistance, as in type 2 diabetes mellitus or have decreased insulin produced by the pancreas, as in type 1. Without the action of insulin, the blood sugar rises. This ultimately results in increased urination, leading to dehydration.

Symptoms experienced by patients in a hyperosmolar hyperglycemic state may vary. They usually have a history of increased urination, increased thirst, and poor appetite. With a further rise in blood sugar, they could be confused and eventually pass out. Fainting, dizziness, and rapid heart rate are other possible symptoms.

Also Read: HbA1c Test For Diabetes

The State of Hyperosmolar Hyperglycemia


The state of hyperosmolar hyperglycemia occurs mainly in people with type 2 diabetes. This condition is characterized by hyperglycemia, often greater than 30 mmol / L, and severe dehydration.

In hyperglycemia, the accumulation of glucose in the blood increases the frequency and volume of urine. This can cause excessive water loss and cause severe dehydration. A drop in blood pressure may ensue, leading to altered consciousness and possibly coma if no medical intervention is taken.

The lack of insulin is the cause. However, unlike diabetic ketoacidosis, there is usually no significant accumulation of ketones in the blood or urine since insulin is not absent.

Hyperosmolar Hyperglycemic State

The symptoms are mainly hyperglycemia, such as frequent and abundant urine, intense thirst and significant fatigue, and signs of dehydration such as dry mouth, hollow eyes, less elastic skin, etc.

People with impaired kidney function are more likely to experience episodes of the hyperglycemic hyperosmolar syndrome because the kidney is less efficient at eliminating excess glucose from the blood during hyperglycemia.

The elderly, who feel less thirsty, are also at greater risk.

Also Read: Homeopathic Medicine For Diabetes

When to Consult Urgently?

See a doctor without delay if one or more of the following occurs:

  • No fluids are tolerated due to vomiting or diarrhea;
  • There is a variation in the person’s state of consciousness, such as confusion, agitation, lack of reaction to stimulation, hallucinations or unusual behavior;
  • There are signs of dehydration: dry mouth, sunken eyes, less elastic skin, etc;
  • Body temperature has been above 38.5 ° C for more than 48 hours.

In people with type 1 diabetes:

Blood glucose level is steeper than 14 mmol / L, and there is the presence of ketone bodies:

  • In urine: “medium” to “strong” level (value above four mmol / L)
  • In the blood: value above 1.5 mmol / L

Blood sugar is above 20 mmol / L with nausea, vomiting and abdominal pain

In people with type 2 diabetes:

Blood sugar is above 25 mmol / L with excessive drowsiness.

Prevent Hyperglycemic Emergencies


In addition to essential tips for preventing high blood sugar, the following recommendations can help you avoid a high blood sugar emergency.

For the person with type 1 diabetes:

  • Check for ketones in blood or urine when blood sugar is above 14mmol / L or on sick days.
  • Measure blood sugar more frequently and follow the protocol established by your healthcare team on sick days.
  • Hydrate adequately if blood sugar is above 14 mmol / L.

For the person with type 2 diabetes:

  • Measure blood sugar more frequently and follow your healthcare team’s recommendations on sick days.
  • Hydrate adequately (250 ml of water every hour) if blood sugar is above 14 mmol / L.

Another important aspect of treating the hyperglycemic hyperosmolar condition is determining why blood sugar is high. Often, an infection such as pneumonia or urinary tract infection could trigger the chain of events leading to SHH. In other cases, heart attacks or strokes can lead to developing this disease.

Also Read: Blood Sugar Range

What are the Causes of Hyperglycemic Hyperosmolar State?


Hyperglycemic Hyperosmolar State is caused by very high blood sugar, usually in people with type 2 diabetes. EHH does not typically occur in people with type 1 diabetes. Instead, they may have diabetic ketoacidosis. Extremely high blood sugar levels make you urinate a lot more than usual. This leads to severe dehydration and a higher concentration of your blood.

You are more at risk of developing HHE if you have type 2 diabetes and if:

  • You are old
  • You stop taking your diabetes medicine
  • You have an infection or other type of stress on the body, such as a heart attack, stroke or surgery.
  • You don’t drink enough fluids or tend not to feel thirsty
  • You have kidney problems
  • You are taking certain medicines, such as corticosteroids and diuretics.

Treatment for Hyperglycaemic Hyperosmolar


The diagnosis of an hhs hyperglycemia hyperosmolar condition is usually made by incorporating data collected from the patient’s symptoms, physical examination, and laboratory studies. Patients often appear dehydrated on physical examination and have dry mouth and skin. Laboratory results show significantly elevated blood sugar, ranging from 600 to 1200 milligrams per deciliter. They also have an increase in sodium in the blood and an increase in osmolality in the serum, a value that describes the number of substances dissolved in the blood at any given time. Patients may also have reduced kidney function due to the decrease in fluid volume in the body.

Treatment for hyperosmolar hyperglycemia involves giving the patient intravenous fluid and administering insulin. Typically, patients are given 33.8-101.5 ounces (1-3 liters) of fluid over a few hours and then provided additional fluid intravenously at a slower rate for a few days. Patients are also given an insulin infusion immediately, who usually receive a hefty dose of insulin followed by a smaller continuous hourly dose of insulin.

Also Read: Ayurvedic Remedies For High Blood Sugar


What is Kussmaul breathing?

The diabetic ketoacidosis or DKA often causes abnormal patterns in breathing. The Kussmaul breathing is caused by DKA. Under Kussmaul breathing people generally suffer from labored breathing or rapid and deep breathing.

Can HHS cause seizures?

In highly advanced cases of HHS seizures along with other altered mental conditions can occur in patients. It can also lead to a state of coma.

What is the normal range of serum sodium?

The serum sodium level in the body is between the range of 135 to 145 (mEq/L). However, when the level of sodium in the body is below the 135 (mEq/L) it causes Hyponatremia.

What are the symptoms of hyperosmolar nonketotic coma?

The symptoms of hyperosmolar nonketotic coma include weakness in the body, lethargy, exhaustion in some cases, and hyperglycaemic conditions in some.

What is the difference between HHNS vs DKA?

HHNS refers to Hyperglycemic hyperosmolar nonketotic syndrome and DKA refers to Diabetic ketoacidosis. HHNS is more likely to occur in old people with extremely high blood sugar level and are suffering from type 2 diabetes. However, DKA is a complication that occurs in people suffering from type 1 diabetes.

What are the consequences of hyperglycemia?

In the long term, too much sugar in the body can cause serious health problems (complications from diabetes), such as a heart attack, stroke, kidney failure, blindness (going blind) or an amputation.
Very high blood sugar levels can signify a serious and life-threatening condition called diabetic ketoacidosis (AD) or hyperglycemia hyperosmolar state (HHS). Fortunately, this health problem is rare. Getting medical attention is recommended as soon as possible if you develop this condition.
See a doctor if you have signs of high blood sugar and are ill. Speak with your doctor about how to manage your diabetes when you are sick.

How Do Doctors Treat HHS?

Doctors treat hhs syndrome in the hospital with:

  • Fluids and electrolytes (minerals necessary for your body to function normally) in a vein
  • Insulin is a vein
  • Frequent blood tests to make sure your blood sugar and electrolyte levels are returning to normal values

Doctors also treat any other problems caused by HEH.

How can doctors tell if I have hyperglycemic hyperosmolar state?

Doctors may think you have hyperglycemic hyperosmolar syndrome if you have diabetes and appear to be confused. They make sure of this by carrying out:

  1. Blood and urine tests

What are the symptoms of hyperglycemic hyperosmolar state?

The First hyperosmolar hyperglycemic state symptoms are:

  • Urinate in large quantities
  • Dry mouth and dry skin
  • The sensation of intense thirst
  • Changes in mental status, such as extreme drowsiness or confusion

In the absence of early treatment, you may also have:

  • Coma or hhnc
  • Convulsions


Last Updated on by Dr. Damanjit Duggal 


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