Diabetic hyperglycemic hyperosmolar syndromeHHS; Hyperglycemic hyperosmolar coma; Nonketotic hyperglycemic hyperosmolar coma (NKHHC); Hyperosmolar nonketotic coma (HONK); Hyperglycemic hyperosmolar non-ketotic state; Diabetes - hyperosmolar
Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of type 2 diabetes . It involves extremely high blood sugar (glucose) level without the presence of ketones.
Type 2 diabetes
Type 2 diabetes is a lifelong (chronic) disease in which there is a high level of sugar (glucose) in the blood. Type 2 diabetes is the most common f...
HHS is a condition of:
- Extremely high blood sugar (glucose) level
Extreme lack of water (
Dehydration occurs when your body does not have as much water and fluids as it should. Dehydration can be mild, moderate, or severe, based on how muc...
- Decreased alertness or consciousness (in many cases)
Buildup of ketones in the body (ketoacidosis) may also occur. But it is unusual and is often mild compared with diabetic ketoacidosis .
Diabetic ketoacidosis is a life-threatening problem that affects people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel ...
HHS is more often seen in people with type 2 diabetes who don't have their diabetes under control. It may also occur in those who have not been diagnosed with diabetes. The condition may be brought on by:
- Other illness, such as heart attack or stroke
- Medicines that decrease the effect of insulin in the body
- Medicines or conditions that increase fluid loss
Normally, the kidneys try to make up for a high glucose level in the blood by allowing the extra glucose to leave the body in the urine. But this also causes the body to lose water. If you do not drink enough water, or you drink fluids that contain sugar and keep eating foods with carbohydrates, the kidneys may become overwhelmed. When this occurs, they are no longer able to get rid of the extra glucose. As a result, the glucose level in your blood can become very high.
The loss of water also makes the blood more concentrated than normal. This is called hyperosmolarity. It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances. This draws the water out of the body's other organs, including the brain.
Risk factors include:
A stressful event such as infection,
, or recent surgery
Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. ...
A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack. " If blood flow is cut off for longer th...
Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptom...
- Impaired thirst
Limited access to water (especially in people with
or who are bedbound)
Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.
- Older age
- Poor kidney function
- Poor management of diabetes, not following the treatment plan as directed
- Stopping insulin or other medicines that lower glucose level
Symptoms may include any of the following:
and urination (at the beginning of the syndrome)
Excessive thirst is an abnormal feeling of always needing to drink fluids.
- Feeling weak
- Weight loss
- Dry mouth, dry tongue
Confusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...
Symptoms may get worse over days or weeks.
Other symptoms that may occur with this disease:
- Loss of feeling or function of muscles
- Problems with movement
- Speech impairment
Exams and Tests
The health care provider will examine you and ask about your symptoms and medical history. The exam may show that you have:
- Extreme dehydration
- Fever higher than 100.4°F (38°C)
The pulse is the number of heartbeats per minute.
- Low systolic blood pressure
Test that may be done include:
Blood osmolarity (concentration)
Blood osmolarity (concentration)
Osmolality is a test that measures the concentration of all chemical particles found in the fluid part of blood. Osmolality can also be measured with...
BUN stands for blood urea nitrogen. Urea nitrogen is what forms when protein breaks down. A test can be done to measure the amount of urea nitrogen ...
The creatinine blood test measures the level of creatinine in the blood. This test is done to see how well your kidneys are working. Creatinine can ...
The sodium blood test measures the amount of sodium in the blood. Sodium can also be measured using a urine test.
A serum ketone test measures how many ketones are there in the blood.
A blood glucose test measures the amount of a sugar called glucose in a sample of your blood. Glucose is a major source of energy for most cells of t...
Evaluation for possible causes may include:
A blood culture is a laboratory test to check for bacteria or other germs in a blood sample.
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds th...
At the start of treatment, the goal is to correct the water loss. This will improve the blood pressure, urine output, and circulation. Blood sugar will also decrease.
Fluids and potassium will be given through a vein ( intravenously ). This must be done carefully. High glucose level is treated with insulin given through a vein.
Intravenous means "within a vein. " Most often it refers to giving medicines or fluids through a needle or tube inserted into a vein. This allows th...
People who develop HHS are often already ill. If not treated right away, seizures, coma, or death may result.
Untreated, HHS may lead to any of the following:
Shock is a life-threatening condition that occurs when the body is not getting enough blood flow. Lack of blood flow means that the cells and organs...
- Blood clot formation
- Brain swelling (cerebral edema)
Increased blood acid level (
Lactic acidosis is when lactic acid builds up in the bloodstream faster than it can be removed. Lactic acid is produced when oxygen levels in the bo...
When to Contact a Medical Professional
This condition is a medical emergency. Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of HHS.
Controlling type 2 diabetes and recognizing the early signs of dehydration and infection can help prevent HHS.
Crandall J, Shamoon H. Diabetes mellitus. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 229.
Graber MN. Diabetes and hyperglycemia. In: Adams JG, ed. Emergency Medicine: Clinical Essentials . 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 162.
Lebovitz HE. Hyperglycemia secondary to nondiabetic conditions and therapies. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 42.
Food and insulin release - illustration
Insulin is a hormone secreted by the pancreas in response to increased glucose levels in the blood.
Food and insulin release
Diabetes - type 2
Diabetes - type 1
Review Date: 2/3/2016
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.