Endocrinology
Hyperosmolar Hyperglycemic State
고삼투성고혈당증후군
Extreme hyperglycemia and hyperosmolarity with minimal ketosis
- How common
- Elderly T2DM complication
- Typical age
- Mostly age ≥60
What is it?
Residual insulin prevents ketogenesis but hyperglycemia + osmotic diuresis cause severe dehydration and hyperosmolarity.
Commonly affected: Systemic (especially brain)
How it develops
- Trigger (infection, MI)Insulin demand surges
- Extreme hyperglycemiaGlucose >600 mg/dL
- Osmotic diuresis + dehydrationFluid loss 9–12 L
- Hyperosmolarity + AMSPlasma osm >320 mOsm/kg
Symptoms
- AMS/comaGradual onset
- Severe dehydrationAverage 9 L deficit
- Neurologic signsSeizures, focal deficits
- No KussmaulUnlike DKA, no/minimal acidosis
How it is examined
- Plasma osmolality>320 mOsm/kg
- Glucose/lytes/BUNGlucose >600, correct Na for glucose
- Workup for triggerInfection/MI/CVA evaluation
Imaging
CXR for pneumonia.
- Pneumonia
Brain CT/MRI for focal neuro signs.
- CVA
Non-surgical care
- Aggressive fluidsNS 1–1.5 L first hour, replace 9–12 L deficit
- Low-dose IV insulin0.05–0.1 U/kg/hr after fluids
- K replacementReplace if K <5.2
- Treat triggerAntibiotics, treat MI
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
None
Outlook
Mortality 10–20% (higher than DKA due to elderly comorbidities).