Hyperosmolar Hyperglycaemic State
Also written as HHS.
Hyperosmolar hyperglycaemic state (HHS) is the other emergency: very high glucose (above about 30 mmol/L), little or no ketosis, severe dehydration and high osmolality, usually in older type 2 patients, with a gradual onset over days.
What our notes say
- Hyperosmolar hyperglycaemic state (HHS) is the other emergency: very high glucose (above about 30 mmol/L), little or no ketosis, severe dehydration and high osmolality, usually in older type 2 patients, with a gradual onset over days. (Diabetic ketoacidosis and hyperglycaemic emergencies)
- | Ketosis | Prone to ketoacidosis (absolute insulin lack permits unrestrained lipolysis/ketogenesis) | Rarely ketotic (residual insulin is usually sufficient to suppress ketogenesis), though hyperosmolar hyperglycaemic state can occur | (General & Systemic Pathology SAQ Paper II — 15 July 2025 (MBPA 3500, MKU Year 3,)
- Hyperosmolar hyperglycaemic state is most associated with: (Chemical Pathology: Endocrine Cases, Pituitary & Thyroid Q&A)
- Hyperosmolar Hyperglycaemic State (HHS): A diabetic emergency characterized by severe hyperglycemia, marked hyperosmolality, profound dehydration, and absence of significant ketosis, often seen in Type 2 diabetes. (Clinical Endocrinology Cases: Pituitary Tumour, PCOS, Type 1 Diabetes, and HHS)
- Onset typically adult/older, obesity-associated; prone to hyperosmolar hyperglycaemic state (HHS) rather than DKA (residual insulin prevents significant ketogenesis) (Ovarian & Colorectal Cancer: Risks, Pathogenesis, Staging)
- Hyperosmolar Hyperglycaemic State (HHS/HONK) — mainly T2DM (ENDOCRINE PATHOLOGY)
Study material on Hyperosmolar Hyperglycaemic State
- Clinical Endocrinology Cases: Pituitary Tumour, PCOS, Type 1 Diabetes, and HHS
- Diabetic ketoacidosis and hyperglycaemic emergencies
- Ovarian & Colorectal Cancer: Risks, Pathogenesis, Staging
- Chemical Pathology: Endocrine Cases, Pituitary & Thyroid Q&A
- Clinical Endocrinology Cases: Pituitary Tumour, PCOS, Type 1 Diabetes, and HHS
- Chemical Pathology MCQS
Practice questions on Hyperosmolar Hyperglycaemic State
Hyperosmolar hyperglycaemic state is most associated with:
- Type 1 diabetes
- Type 2 diabetes
- Insulinoma
- Glucagonoma
- Pheochromocytoma ✅ Answer: B
Answer: A. Hyperosmolar hyperglycaemic state (HHS) is a severe complication predominantly seen in patients with Type 2 diabetes.
Diabetic ketoacidosis (DKA) is distinguished from hyperosmolar hyperglycaemic state (HHS) by
- Higher glucose in DKA
- Presence of significant ketonaemia and acidosis in DKA
- Absence of dehydration in DKA
- Lower osmolality in HHS
Answer: B. DKA: pH <7.3, bicarbonate <15, ketones positive. HHS: minimal ketosis, glucose often >600 mg/dL. ---