Hyperosmolar Hyperglycemic State
(HHS; Hyperosmolar Nonketotic Coma; HHNC)
by Krisha McCoy, MS
Hyperosmolar nonketotic state (HHS) or coma happens in people with diabetes. It is a severe event that needs care.
HHS is caused by very high glucose in the blood. It is often set off by an illness or infection. It can also happen if the diabetes treatment plan is not followed. The body passes extra glucose out in the urine. Too much urine will lower the levels of other important things in the body such as water. This can make it hard for the brain and heart to work.
HHS can happen at any age. It is more common in older adults and people with type 2 diabetes. Other things that may increase the chance of HHS are:
HHS can take days or weeks to start. Warning signs of high blood glucose that leads to HHS are:
Tests for HHS may include:
The heart may also be checked. An EKG can check your heart's electrical activity.
Hospital care will be needed. The goal is to replace fluids and minerals that are low. Glucose will also be brought to normal levels. Treatment may include:
Other treatment may be needed if there is an infection.
To help prevent HHS:
American Diabetes Association
National Institute of Diabetes and Digestive and Kidney Diseases
Canadian Diabetes Association
Hyperglycemic hyperosmolar state in adults. EBSCO DynaMed website. Available at: https://www.dyname... . Updated October 7, 2019. Accessed December 2, 2019.
Hyperglycemic hyperosmolar state in children. EBSCO DynaMed website. Available at: https://www.dyname... . Updated February 9, 2018. Accessed December 2, 2019.
Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009 Jul;32(7):1335-43EBSCOhost Full Text full-text, commentary can be found in Diabetes Care 2009 Dec;32(12):e157.
Scott A, Claydon A. Joint British Diabetes Societies Inpatient Care Group. The management of hyperosmolar hyperglycaemic state (HHS) in adults with diabetes. Joint British Diabetes Societies (JBDS) 2012 Aug PDF, summary of report can be found in Diabet Med 2015 Jun;32(6):714
Umpierrez G, Korytkowski M. Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol. 2016 Apr;12(4):222-32
Last reviewed December 2019 by EBSCO Medical Review Board
Last Updated: 12/2/2019