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Estado hiperglucémico hiperosmolar

Última revisão: 23 Aug 2025
Última atualização: 17 Jun 2025

Resumo

Definição

History and exam

Key diagnostic factors

  • alteración del estado mental
Full details

Other diagnostic factors

  • poliuria
  • polidipsia
  • pérdida de peso
  • debilidad
  • sequedad de mucosas
  • turgencia cutánea reducida
  • taquicardia
  • hipotensión
  • convulsiones
  • hipotermia
  • shock
  • dolor abdominal
  • signos neurológicos focales
Full details

Risk factors

  • infección
  • tratamiento inadecuado con insulina o antidiabéticos orales
  • enfermedad aguda en un paciente con diabetes conocida
  • residentes de residencias de ancianos
  • incapacidad para detectar la hiperglucemia
  • estado postoperatorio
  • medicamentos desencadenantes
  • nutrición parenteral total (NPT)
  • Síndrome de Cushing
  • hipertiroidismo
  • acromegalia
Full details

Diagnostic tests

1st tests to order

  • nivel de glucosa plasmática
  • nivel de cetona sérica o urinaria
  • nivel de urea sérica
  • nivel de creatinina sérica
  • nivel de sodio sérico
  • nivel de potasio sérico
  • nivel de cloruro sérico
  • nivel de magnesio sérico
  • nivel de calcio sérico
  • nivel de fosfato sérico
  • osmolalidad sérica
  • cálculo de la brecha aniónica
  • nivel de lactato sérico
  • gas en sangre
  • análisis de orina
  • pruebas de función hepática
  • hemograma completo (HC)
Full details

Tests to consider

  • radiografía de tórax
  • electrocardiograma (ECG)
  • biomarcadores cardíacos
  • hemocultivos, urocultivos o cultivos de esputo
Full details

Treatment algorithm

ACUTE

todos los pacientes

ONGOING

síndrome hiperosmolar hiperglucémico (SHH) resuelto y paciente capaz de tolerar ingesta oral

Contributors

Authors

Guillermo Umpierrez, MD

Professor of Medicine

Emory University School of Medicine

Atlanta

GA

Disclosures

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

Peer reviewers

Daniel Morganstein, MBBS, MA (Cantab), MRCP, PhD

Consultant Diabetologist

Beta Cell Unit

Chelsea and Westminster NHS Trust

London

UK

Disclosures

DM declares that he has no competing interests.

M. Cecilia Lansang, MD

Department of Medicine

Division of Endocrinology and Metabolism

Gainesville

University of Florida

FL

Disclosures

MCL has received speaker fees from Sanofi-Aventis and Novo Nordisk, makers of insulin products.

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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

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.Full text  Abstract

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.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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