高渗性高血糖状态在 2 型糖尿病老年患者中最为常见。在所有与糖尿病相关住院量中占比少于 1%。但是，死亡率较高（5% 至 20%）。
表现为多尿、多饮、虚弱、体重减轻、心动过速、粘膜干燥、皮肤不够充盈、低血压，严重病例中出现休克。
知觉改变（倦怠、定向障碍、木僵）是很常见的症状，与有效血清渗透压浓度最为相关。 罕见昏迷，如果发生该症状，通常与血清渗透压浓度 ＞ 340 mmol/kg (＞ 340 mOsm/kg) 相关。
治疗手段包括纠正体液不足和电解质紊乱以及静脉注射胰岛素。
高渗性高血糖状态（hyperosmolar hyperglycaemic state, HHS），亦称为非酮症高渗性高血糖综合征，特征为显著的高血糖（血糖 >33.3 mmol/L [＞600 mg/dL]）、高渗血症（有效血清渗透压 ≥320 mmol/kg [≥320 mOsm/kg]）和血容量减少而无明显酮症酸中毒（pH >7.3 且 HCO₃ >15 mmol/L [>15 mEq/L]），是一种严重的糖尿病并发症。HHS 可能是 2 型糖尿病首发症状。[1]Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009 Jul;32(7):1335-43.
http://care.diabetesjournals.org/content/32/7/1335.long
http://www.ncbi.nlm.nih.gov/pubmed/19564476?tool=bestpractice.com
虽然通常将 HHS 和糖尿病酮症酸中毒（diabetic ketoacidosis,DKA）作为不同的疾病来讨论，但它们同属糖尿病代谢紊乱范畴内的两种代表性疾病。[2]Stoner GD. Hyperosmolar hyperglycemic state. Am Fam Physician. 2017 Dec 1;96(11):729-36.
https://www.aafp.org/afp/2017/1201/p729.html
http://www.ncbi.nlm.nih.gov/pubmed/29431405?tool=bestpractice.com
[3]Fayfman M, Pasquel FJ, Umpierrez GE. Management of hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Med Clin North Am. 2017 May;101(3):587-606.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6535398/
http://www.ncbi.nlm.nih.gov/pubmed/28372715?tool=bestpractice.com
HHS 和 DKA 具有胰岛素相对或绝对缺乏以及反调节激素升高的特征。[1]Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009 Jul;32(7):1335-43.
http://care.diabetesjournals.org/content/32/7/1335.long
http://www.ncbi.nlm.nih.gov/pubmed/19564476?tool=bestpractice.com
[4]Wolfsdorf JI, Glaser N, Agus M, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes. 2018 Oct;19 Suppl 27:155-77.
https://onlinelibrary.wiley.com/doi/full/10.1111/pedi.12701
http://www.ncbi.nlm.nih.gov/pubmed/29900641?tool=bestpractice.com
大约 33% 的高血糖危象的患者表现为 DKA 和 HHS 的混合症状。[5]Wachtel TJ, Tetu-Mouradjian LM, Goldman DL, et al. Hyperosmolarity and acidosis in diabetes mellitus: a three-year experience in Rhode Island. J Gen Intern Med. 1991 Nov-Dec;6(6):495-502.
http://www.ncbi.nlm.nih.gov/pubmed/1765864?tool=bestpractice.com
感染是最常见的诱发因素。[6]Pasquel FJ, Tsegka K, Wang H, et al. Clinical outcomes in patients with isolated or combined diabetic ketoacidosis and hyperosmolar hyperglycemic state: a retrospective, hospital-based cohort study. Diabetes Care. 2020 Feb;43(2):349-57.
https://care.diabetesjournals.org/content/43/2/349.long
http://www.ncbi.nlm.nih.gov/pubmed/31704689?tool=bestpractice.com