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Estado hiperosmolar hiperglicêmico

Last reviewed: 21 Jul 2025
Last updated: 17 Jun 2025

Summary

Definition

History and exam

Key diagnostic factors

  • estado mental alterado
Full details

Other diagnostic factors

  • poliúria
  • polidipsia
  • perda de peso
  • fraqueza
  • membranas mucosas ressecadas
  • turgor cutâneo diminuído
  • taquicardia
  • hipotensão
  • convulsões
  • hipotermia
  • choque
  • dor abdominal
  • sinais neurológicos focais
Full details

Risk factors

  • infecção
  • insulinoterapia ou tratamento com antidiabéticos orais inadequados
  • doença aguda em paciente com diabetes conhecido
  • residentes de instituições asilares
  • falha em detectar a hiperglicemia
  • estado pós-operatório
  • medicamentos precipitadores
  • nutrição parenteral total (NPT)
  • Síndrome de Cushing
  • hipertireoidismo
  • acromegalia
Full details

Diagnostic investigations

1st investigations to order

  • nível de glicose plasmática
  • nível de corpos cetônicos séricos ou urinários
  • nível de ureia sérica
  • nível de creatinina sérica
  • nível de sódio sérico
  • nível de potássio sérico
  • nível de cloreto sérico
  • nível de magnésio sérico
  • nível de cálcio sérico
  • nível de fosfato sérico
  • osmolalidade sérica
  • cálculo do anion gap
  • nível de lactato sérico
  • gasometria
  • urinálise
  • testes da função hepática
  • Hemograma completo
Full details

Investigations to consider

  • radiografia torácica
  • eletrocardiograma (ECG)
  • biomarcadores cardíacos
  • culturas de sangue, urina ou escarro
Full details

Treatment algorithm

ACUTE

todos os pacientes

ONGOING

síndrome hiperglicêmica hiperosmolar (SHH) remitida e paciente capaz de tolerar a ingestão 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.

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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    • Standards of care in diabetes - 2024
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  • Patient information

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