Hyperglycemic Hypernatremic Hypertonic State: A Predominant Hyperglycemic Hyperosmolar State (HHS) Subtype and Its Clinical and Diagnostic Features
Authors' conclusion
HHS with hypernatremia, defined by corrected sodium, is highly prevalent and clinically relevant, as corrected sodium better reflects the true free water deficit. HHS management should include evaluating both measured and corrected sodium, adopting effective serum osmolarity > 300 mOsm/L as a more sensitive diagnostic criterion, and reevaluating the exclusion criteria of significant ketonemia and acidosis. These refinements may enhance diagnostic accuracy and enable more personalized fluid management in HHS.
Study context
- Population
- Consecutive adults with diabetes admitted with HHS, 2018–2024, single institution
- Participants
- 174 adults
- Outcome
- Prevalence of HHS with hypernatremia (measured and corrected sodium)
Methodological detailssingle-centre, consecutive patients
- Single-centre
- Consecutive patients
Main finding
As reported in the abstract
Hypernatremia by measured sodium (>145 mmol/L)
14/174, 8%
Hypernatremia by corrected sodium for hyperglycemia
166/174; 95.4%
Observational data: associations, not effects.
Further findings
Diagnostic sensitivity of osmolarity criteria
- Effective serum osmolarity >300 mOsm/L more sensitive than total serum osmolarity >320 mOsm/L for diagnosing HHS
Concurrent diabetic ketoacidosis (DKA)
- HHS cases with concurrent DKA
- 65.5% (114/174)
Original publication
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