Hyperosmolar hyperglycemic state natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

Overview

The symptoms of hyperosmolar hyperglycemic state (HHS) develop slowly over a period of days to weeks as compared to diabetic ketoacidosis which presents within hours of inciting event. The symptoms range from fatigue, weakness, leg cramps, polyuria, dehydration and eventually seizures and coma. If left untreated, patients may develop multiorgan failure and eventually death. Common complications are renal failure, thrombotic events, and cardiovascular complications. The complications due to treatment can be cerebral edema, pulmonary edema, hypoglycemia, and electrolyte imbalance. The mortality rate ranges from 5-20% which is ten times higher than diabetic ketoacidosis. The prognosis of the hyperosmolar hyperglycemic state (HHS) depends on the hemodynamic status, comorbidities, and age at the time of presentation.

Natural History, Complications, and Prognosis

Natural History

Complications

People with hyperosmolar hyperglycemic state (HHS) need close and frequent monitoring for complications. Surprisingly, the most common complications of HHS are related to the treatment:[1][2][3][4]

Complications of hyperosmolar hyperglycemic state (HHS) include:

Complications due to the treatment of hyperosmolar hyperglycemic state (HHS) include:

Prognosis

The mortality of hyperosmolar hyperglycemic state ranges from 5% to 20%, which is ten times higher than diabetic ketoacidosis. The signs of poor prognosis in hyperosmolar hyperglycemic state (HHS) at the time of diagnosis include:[5][6][7]

References

  1. Muir AB, Quisling RG, Yang MC, Rosenbloom AL (2004). "Cerebral edema in childhood diabetic ketoacidosis: natural history, radiographic findings, and early identification". Diabetes Care. 27 (7): 1541–6. PMID 15220225.
  2. "Diabetic ketoacidosis". Diabetic ketoacidosis. Mayo Foundation for Medical Education and Research. 2006. Retrieved 2007-06-15. Text " By Mayo Clinic Staff " ignored (help)
  3. "Diabetic Coma > Diabetic ketoacidosis". Diabetic ketoacidosis. Armenian Medical Network. 2006. Retrieved 2007-06-15. Text " Umesh Masharani, MB, BS, MRCP " ignored (help)
  4. "Diabetic ketoacidosis complications". Diabetic ketoacidosis. The Diabetes Monitor. 2007. Retrieved 2007-06-15.
  5. Liu WY, Lin SG, Wang LR, Fang CC, Lin YQ, Braddock M, Zhu GQ, Zhang Z, Zheng MH, Shen FX (2016). "Platelet-to-Lymphocyte Ratio: A Novel Prognostic Factor for Prediction of 90-day Outcomes in Critically Ill Patients With Diabetic Ketoacidosis". Medicine (Baltimore). 95 (4): e2596. doi:10.1097/MD.0000000000002596. PMC 5291578. PMID 26825908.
  6. Gale EA, Tattersall RB (1978). "Hypothermia: a complication of diabetic ketoacidosis". Br Med J. 2 (6149): 1387–9. PMC 1608617. PMID 102402.
  7. Al-Matrafi J, Vethamuthu J, Feber J (2009). "Severe acute renal failure in a patient with diabetic ketoacidosis". Saudi J Kidney Dis Transpl. 20 (5): 831–4. PMID 19736483.

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