The document discusses hyperosmolar hyperglycemic state (EHH), characterized by hyperglycemia (>600 mg/dL) and hyperosmolality (>320 mOsm/L) without significant ketoacidosis or acidosis. EHH commonly occurs in elderly patients with type 2 diabetes and can cause stupor or coma. Diagnosis is based on high blood glucose and normal pH and bicarbonate levels. Treatment involves fluid replacement and insulin to correct dehydration and hyperglycemia while monitoring for complications. Resolution is defined as plasma osmolality below 315 mosmol/kg and ability of the patient to eat.
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)].
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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.