Wednesday, October 16, 2013

Q: How much is the average fluid deficit in Hyperosmolar hyperglycemic state (HHS), previously known as hyperosmolar hyperglycemic nonketotic coma (HHNK)?

Answer:  About 9 liters

According to the consensus statement published by the American Diabetes Association, diagnostic features of HHS may include
  • Plasma glucose level of 600 mg/dL or greater
  • Effective serum osmolality of 320 mOsm/kg or greater
  • Profound dehydration, up to an average of 9L
  • Serum pH greater than 7.30
  • Bicarbonate concentration greater than 15 mEq/L
  • Small ketonuria and absent-to-low ketonemia
  • Some alteration in consciousness


Kitabchi AE, Umpierrez GE, Murphy MB, Kreisberg RA. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. Dec 2006;29(12):2739-48

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