Hyperosmolar Hyperglycemic Syndrome (HHS)

Etiology

  • Patients w/type 2 DM who are either not taking (enough) insulin and/or have increased resistance due to a concomitant stressor: infection, MI, PE, pancreatitis, meds (steroids), other precipitant

Risk Factors

  • Poorly controlled type 2 dm
  • Older age, significant co-morbid illnesses

Symptoms

  • Confusion to obtundation
  • May have felt weak, N, V, fatigued prior
  • Polyuria, polydypsia
  • Fever, pain, other localizing sign related to underlying problem (e.g. infection, MI, etc).

Physical Exam Findings

  • Can be very ill appearing
  • Fever if related to infection
  • Often tachycardia, low bp, tachypnea - w/degree of abnormality based on severity and level of compensation
  • May have focal exam findings based on primary problem (e.g. findings of pneumonia, intra-abdominal infection, etc).

Tests