Table HYPERGLYCEMIC-HYPEROSMOLAR STATE.docx

Insulin remains available in amounts sufficient to

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Insulin remains available in amounts sufficient to inhibit lipolysis and ketogenesis but insufficient to prevent hyperglycemia. Hyperosmolarity itself may also decrease lipolysis, limiting the ketogenesis. 2 Etiology HHS most commonly occurs in patients with type 2 DM who have some concomitant illness that leads to reduced fluid intake. Any illness that predisposes to dehydration or to reduced insulin activity may lead to HHS. Acute febrile illnesses, including infections, account for the largest proportion of HHS cases. A preceding or intercurrent infection is the single most common cause. 3 Epidemiology The exact incidence of HHS is not known, because population-based studies of HHS have not been conducted. It has been estimated that out of all primary diabetic hospital admissions, less than 1% are for HHS. As the prevalence of type 2 DM increases, the incidence of HHS will likely increase as well. The most at-risk population consists of the elderly or chronically ill, who in many cases have decreased thirst. 4 Clinical Manifestations Patients may present with polydipsia and polyuria, depending on hydration status. Other common symptoms include nausea, vomiting, weakness, lethargy, and muscle cramps. They do not typically report abdominal pain, a complaint that is often noted in patients with DKA. In more advanced HHS, presentation is more likely to be altered mental status, seizures and/or coma, an underlying fever.
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