This week looking at something different, a diabetic condition which has up to 20x the mortality of diabetic ketoacidosis (DKA).
Hyperosmolar Hyperglycemic State (HHS) – previously referred to as hyperglycemic hyperosmolar nonketotic coma (HONK) – is a metabolic complication of diabetes mellitus (DM) characterised by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. It most often occurs in type 2 DM, often in the setting of physiologic stress.
![](https://www.paramedicine.education/wp-content/uploads/2020/07/hss.jpg)
HHS is diagnosed by severe hyperglycemia and plasma hyperosmolality and absence of significant ketosis. Complications include coma, seizures, and death. It has an estimated mortality rate of up to 20%, which is significantly higher than the mortality for diabetic ketoacidosis (DKA), currently < 1%.
![](https://www.paramedicine.education/wp-content/uploads/2020/07/101393863_10207675755567595_6511299368539127808_n.jpg)
Further reading, if interested, can be found at:
https://www1.racgp.org.au/ajgp/2019/may/hyperglycaemic-presentations-in-type-2-diabetes
Remember that each of these discussions count towards your annual CPD total – perhaps only a few minutes for reading my post, but longer if you read the linked article.