Hyperosmolair hyperglykemisch syndroom

Hyperosmolar Hyperglycemic State, or HHS, is a life-threatening complication of type 2 diabetes characterized by severe hyperglycemia, profound dehydration, and elevated serum osmolality without significant ketoacidosis.

It often arises from severe insulin resistance and relative insulin deficiency, especially in older adults or those with limited fluid intake due to illness, or medications such as diuretics and corticosteroids.

These factors, combined with osmotic diuresis from extremely high blood glucose, lead to massive fluid loss and a rise in serum osmolality.

Unlike diabetic ketoacidosis, patients with HHS produce enough insulin to inhibit ketone formation but not enough to control blood glucose, resulting in minimal or absent ketones and no significant acidosis.

In HHS, blood glucose exceeds 600 milligrams per deciliter, well above the renal reabsorption threshold, leading to glucose excretion in urine, osmotic diuresis, and a rise in serum osmolality above 320 milliosmoles per kilogram.