Abstract

The hyperosmolar hyperglycemic state is typically characterized by hyperglycemia and dehydration caused by osmotic diuresis, which leads to hyperviscosity and a hypercoagulable state. Hyperosmolar hyperglycemic state occurs most commonly in elderly patients with type 2 diabetes mellitus. Infection represents the commonest precipitating cause of hyperosmolar hyperglycemic state in essentially all series and occurs in 40–60% of patients. The hallmark of hyperosmolar hyperglycemic state pathogenesis is an extreme elevation in serum glucose level and hyperosmolality without significant ketosis. These metabolic disturbances result from synergistic factors, including lack of insulin and increased counterregulatory hormone levels (glucagon, catecholamines, cortisol, and growth hormone). The goals of hyperosmolar hyperglycemic state treatment include correction of volume deficits while reducing and normalizing plasma hyperosmolality, which will correct hyperglycemia, uncovering and managing the underlying cause, resolving ketonemia, correcting acidosis, re-establishing euglycemia, improving mental status, optimizing renal perfusion, replenishing electrolytes and minerals, and avoiding complications. The goal of initial fluid therapy is expansion of the intra- and extravascular volume and restoration of normal renal perfusion. Vigorous fluid replacement is recommended for adults with hyperosmolar hyperglycemic state and rates of fluid replacement for hyperosmolar hyperglycemic state in children similarly should be more rapid than those recommended for diabetic ketoacidosis. The American diabetes association guideline recommends starting intravenous regular insulin in the same way as during diabetic ketoacidosis management. That is, starting intravenous regular insulin at either a fixed weight-based dose of 0.14 units/ kg/h or at a fixed weight-based dose of 0.1units/kg/h followed by a 0.1 units/kg bolus of intravenous insulin after initiation of fluid resuscitation and correction of any hypokalemia.

Keywords: Background; Hyperosmolar Hyperglycemic State; Management; Pathophysiology; Precipitating Factors.