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Hyperglycemic Hyperosmolar Syndrome (HHS)
HHS accounts for 5-15 % of hospital admissions for diabetic coma. (49) Mortality rates are reported as high as 50%. (19) This disorder resembles DKA (dehydration, altered mental status) although blood glucose levels are much higher (up to 2000 mg/dL), Kussmaul respiration is rare, and there is the absence of ketosis. There is a reduction in the rate of glomerular filtration and glucose excretion. (19,49,50)
HHS occurs mostly in diagnosed and undiagnosed Type 2 diabetics over the age of 60.
Health care providers should be suspect of elderly patients demonstrating any of these precipitating factors. Individuals may exhibit central nervous system distress (e.g., hallucinations, focal or grand mal seizures). Early recognition of symptoms and timely intervention are key in preventing onset. Treatment is similar to that of DKA and consists of intravenous administration of fluids, electrolytes and insulin. The result of treatment may make the patient more sensitive to further insulin. Glucose control can be attained through a combination of diet, exercise and oral hypoglycemic agents or insulin. Patient education should include an understanding of the warning signs of onset of HHS and glucose monitoring techniques. (49,50)
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Hyperosmolar Syndrome
