Hyperosmolar hyperglycemic state laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Laboratory findings consistent with the diagnosis of hyperosmolar hyperglycemic state (HHS) include plasma glucose > 600 mg/dl, serum osmolarity > 320 mOsm/kg, blood pH > 7.3, serum bicarbonate > 18 mEq/L and negative or trace positive urine or serum ketones.

Laboratory Findings

The following lab abnormalities may be found in hyperosmolar hyperglycemic state (HHS):[1][2][3][4][5][6][7]

LAB FORMULA/ VARIABLE NORMAL VALUE VALUE IN HHS
Plasma glucose (mg/dL)
  • N/A
  • < 200 mg/dl
  • > 600 mg/dl
Arterial ph
  • 7.35-7.45
  • > 7.30
Anion gap
  • (Na+) – (Cl– + HCO3–)
  • 7 to 13 (mEq/L)
  • Variable
Serum osmolality
  • 285 to 295 mOsm/kg (285 to 295 mmol/kg) of water
  • Increased (> 320mOsm/kg)
Plasma ketones
  • Trace or negative
Urine ketones
  • Trace or negative
Serum Bicarbonate
  • 23 - 29 mEq/L
  • > 18 mEq/L
Blood urea nitrogen, creatinine levels
  • N/A
  • 7-20 mg/dl
  • 0.8-1.2mg/dl
Complete blood count (with differential)
  • N/A
  • Increased

References

  1. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). "Hyperglycemic crises in adult patients with diabetes". Diabetes Care. 32 (7): 1335–43. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.
  2. Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JM, Fournier H, Havrankova J (2003). "Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state". CMAJ. 168 (7): 859–66. PMC 151994. PMID 12668546.
  3. Liamis G, Liberopoulos E, Barkas F, Elisaf M (2014). "Diabetes mellitus and electrolyte disorders". World J Clin Cases. 2 (10): 488–96. doi:10.12998/wjcc.v2.i10.488. PMC 4198400. PMID 25325058.
  4. Adrogué HJ, Lederer ED, Suki WN, Eknoyan G (1986). "Determinants of plasma potassium levels in diabetic ketoacidosis". Medicine (Baltimore). 65 (3): 163–72. PMID 3084904.
  5. Xu W, Wu HF, Ma SG, Bai F, Hu W, Jin Y, Liu H (2013). "Correlation between peripheral white blood cell counts and hyperglycemic emergencies". Int J Med Sci. 10 (6): 758–65. doi:10.7150/ijms.6155. PMC 3638300. PMID 23630441.
  6. Molitch ME, Rodman E, Hirsch CA, Dubinsky E (1980). "Spurious serum creatinine elevations in ketoacidosis". Ann. Intern. Med. 93 (2): 280–1. PMID 6773457.
  7. Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G (2000). "Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room". Am. J. Nephrol. 20 (4): 319–23. doi:13607 Check |doi= value (help). PMID 10970986.

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