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2014 ; 37
(11
): 3124-31
Nephropedia Template TP
gab.com Text
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English Wikipedia
Hyperosmolar hyperglycemic state: a historic review of the clinical presentation,
diagnosis, and treatment
#MMPMID25342831
Pasquel FJ
; Umpierrez GE
Diabetes Care
2014[Nov]; 37
(11
): 3124-31
PMID25342831
show ga
The hyperosmolar hyperglycemic state (HHS) is the most serious acute
hyperglycemic emergency in patients with type 2 diabetes. von Frerichs and
Dreschfeld described the first cases of HHS in the 1880s in patients with an
"unusual diabetic coma" characterized by severe hyperglycemia and glycosuria in
the absence of Kussmaul breathing, with a fruity breath odor or positive acetone
test in the urine. Current diagnostic HHS criteria include a plasma glucose level
>600 mg/dL and increased effective plasma osmolality >320 mOsm/kg in the absence
of ketoacidosis. The incidence of HHS is estimated to be <1% of hospital
admissions of patients with diabetes. The reported mortality is between 10 and
20%, which is about 10 times higher than the mortality rate in patients with
diabetic ketoacidosis (DKA). Despite the severity of this condition, no
prospective, randomized studies have determined best treatment strategies in
patients with HHS, and its management has largely been extrapolated from studies
of patients with DKA. There are many unresolved questions that need to be
addressed in prospective clinical trials regarding the pathogenesis and treatment
of pediatric and adult patients with HHS.