2. Estado Hiperosmolar Hiperglucémico (EHH)
“ Hiperglucemia (glucosa sérica >600mg/dl) e
hiperosmolaridad (>320mOsm/L) en ausencia de
cetonemia significativa y acidosis ”
4. Estado Hiperosmolar Hiperglucémico (EHH)
Frecuencia DM2 > DM1.
Edad media 65 años
Debutan con EHH 30-40%.
< 1% de admisiones por DM.
Mortalidad de al menos 10%.
Cetosis moderada es comun
Coma <30%.
6. Diagnóstico EHH
Criterios diagnósticos EHH :
a. Glucosa sérica >600 mg/dl
b. pH arterial >7.3
c. bicarbonato sérico >15 mEq/l
d. and mínima cetonuria and cetonemia.
7. Table 203.1 Diagnostic Criteria for DKA and HHS
DKA
Mild Moderate Severe HHS
Diagnostic criteria and
classification
Plasma glucose (mg/dL) >250 >250 mg/dL >250 mg/dL >600 mg/dL
mg/dL
Arterial pH 7.25– 7.00 to <7.25 <7.00 >7.30
7.30
Serum bicarbonate (mEq/L) 15–18 10 to <15 <10 >15
Urine ketonea Positive Positive Positive Small
Serum ketonea Positive Positive Positive Small
Effective serum osmolalityb Variable Variable Variable >320 mOsm/kg
Anion gapc >10 >12 >12 <12
Mental status Alert Alert/drowsy Stupor/coma Stupor/coma
DKA, diabetic ketoacidosis; HHS, hyperosmolar hyperglycemic state.
aNitroprusside reaction method.
bCalculation of effective serum osmolality: 2[measured Na+ (mEq/L)] + [glucose (mg/dL)]/18.
cCalculation of anion gap: (Na+) - [Cl- + HCO - (mEq/L)].
3
Source: Modified from Kitabchi AE, Umpierrez GE, Murphy MB, et al. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes
Association. Diabetes Care 2006;29:2739–2748.