Hyperglycaemic hyperosmolar state
Diagnosis of HHS and mixed DKA/HHS, slow rehydration with osmolality targets, low-dose insulin only when needed, and the thrombosis, foot and osmotic risks.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- HHS is severe hyperglycaemia and dehydration without significant ketoacidosis, typically in an older person with type 2 diabetes after days of illness. Fluid deficits are huge, often 100 to 220 mL/kg (10 to 22 L in a 100 kg adult).
- Mortality is higher than in DKA (about 5 to 20%), mostly from the precipitant, thrombosis and age.
- Treatment is fluid first. Insulin is low dose and, in pure HHS, often delayed until fluids alone stop lowering the glucose.
Loading the rest of the note…
Finished reading?
Sources
- Management of hyperosmolar hyperglycaemic state (HHS) in adults: an updated guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care GroupJBDS for Inpatient Care (Mustafa et al., Diabetic Medicine 2023;40:e15005), 2022
- Hyperglycemic crises in adults with diabetes: a consensus reportADA, EASD, JBDS, AACE and DTS (Umpierrez et al., Diabetes Care 2024;47:1257-75), 2024
- Emergency management of hyperglycaemia in primary careAU/NZRACGP and Australian Diabetes Society, 2018
- Diabetes (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy