Hyperosmolar hyperglycemic state

Hyperosmolar hyperglycemic state (HHS) (previously known as hyperosmolar non-ketotic coma (HONK)) is a serious metabolic derangement that can occur in patients with diabetes mellitus, predominantly those with type 2. While there are no distinct imaging features, it is useful for a radiologist to be familiar with this condition.

It usually occurs in type 2 diabetics who have some concomitant illness that leads to reduced fluid intake. The typical patient is 50-70 years old and there may be a precipitating event such as a stroke, MI, chest/urinary infection or systemic inflammatory response 2.

High blood glucose levels lead to severe dehydration, increases in osmolarity (relative concentration of solute) and, in turn, carries a high risk of complications, coma and death.

Hyperosmolar hyperglycemic state is common in more elderly diabetic patients and is associated with volume depletion without a compensating fluid intake. Principles of management are as follows 2:

  • correction of volume depletion with intravenous fluids
  • insulin infusion to correct high blood sugar levels (BSLs)
    • rehydration often produces significant reductions in BSLs and HHS patients often require less insulin than DKA patients
  • BSL and electrolyte monitoring
  • search for precipitating cause

Hyperosmolar hyperglycemic state is thought to have been first described by von Frerichs and Dreschfeld in the 1880s 1.

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Article information

rID: 38710
Synonyms or Alternate Spellings:
  • HONK
  • Non-ketotic hyperglycaemia
  • Hyperosmolar non-ketotic coma (HONK)
  • Hyperosmolar hyperglycaemic state (HHS)
  • Nonketotic hyperglycaemia

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