Hyperosmolar hyperglycemic state

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Last reviewed: 19 Aug 2025
Last updated: 10 Sep 2025

Summary

Definition

História e exame físico

Principais fatores diagnósticos

  • altered mental status
Detalhes completos

Outros fatores diagnósticos

  • polyuria
  • polydipsia
  • weight loss
  • weakness
  • dry mucous membranes
  • poor skin turgor
  • tachycardia
  • hypotension
  • seizures
  • hypothermia
  • shock
  • abdominal pain
  • focal neurologic signs
Detalhes completos

Fatores de risco

  • infection
  • inadequate insulin or oral antidiabetic therapy
  • acute illness in a known patient with diabetes
  • nursing home residents
  • failure to detect hyperglycemia
  • postoperative state
  • use of certain drugs
  • total parenteral nutrition (TPN)
  • Cushing syndrome
  • hyperthyroidism
  • acromegaly
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • plasma glucose level
  • serum or urinary ketone level
  • serum BUN level
  • serum creatinine level
  • serum sodium level
  • serum potassium level
  • serum chloride level
  • serum magnesium level
  • serum phosphate level
  • serum osmolality
  • anion gap calculation
  • serum lactate level
  • blood gas
  • urinalysis
  • liver function tests
  • CBC
Detalhes completos

Investigações a serem consideradas

  • chest x-ray
  • ECG
  • cardiac biomarkers
  • blood, urine, or sputum cultures
Detalhes completos

Algoritmo de tratamento

AGUDA

all patients

CONTÍNUA

hyperosmolar hyperglycemic state (HHS) resolved and patient able to tolerate oral intake

Colaboradores

Consultores especialistas

Guillermo Umpierrez, MD

Professor of Medicine

Emory University School of Medicine

Atlanta

GA

Declarações

GU has received research grants from AstraZeneca, Dexcom, and Bayer. GU is an author of a number of references cited in this topic.

Revisores

William B. Horton, MD, MSc, FACP

Assistant Professor of Medicine

University of Virginia School of Medicine

Charlottesville

VA

Declarações

WBH has been a principal investigator for several grants from nonprofit funding sources including the National Institutes of Health, the Juvenile Diabetes Research Foundation, and the American Heart Association. WBH was a contributor to the Diabetes Textbook: Clinical principles, patient management and public health issues, Springer Nature Switzerland AG 2019, having written a chapter about inpatient management of diabetes and hyperglycemia for which he received no fee.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycaemic crises in adults with diabetes: a consensus report. Diabetologia. 2024 Aug;67(8):1455-79.Texto completo  Resumo

Mustafa OG, Haq M, Dashora U, et al. Management of hyperosmolar hyperglycaemic state (HHS) in adults: an updated guideline from the Joint British Diabetes Societies (JBDS) for inpatient care group. Diabet Med. 2023 Mar;40(3):e15005.Texto completo  Resumo

Diabetes Canada Clinical Practice Guidelines Expert Committee, Goguen J, Gilbert J. Hyperglycemic emergencies in adults. Can J Diabetes. 2018 Apr;42(suppl 1):S109-14.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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