Hyperosmolar Syndrome
Basics
Description
Description
- Results from a relative insulin deficiency in the undiagnosed or untreated diabetic
- Sustained hyperglycemia creates an osmotic diuresis and dehydration:
- Extracellular space maintained by the osmotic gradient at the expense of the intracellular space
- Eventually profound intracellular dehydration occurs
- Total body deficits of H2O, Na+, Cl−, K−, PO4−, Ca2+, and Mg2+
- In contrast to diabetic ketoacidosis (DKA), severe ketoacidosis does not occur:
- Circulating insulin levels are higher
- The elevation of insulin counter-regulatory hormones is less marked
- The hyperosmolar state itself inhibits lipolysis (the release of free fatty acids) and subsequent generation of keto acids
Geriatric Considerations
- Most commonly seen in elderly type II diabetics who experience a stressful illness that precipitates worsening hyperglycemia and reduced renal function
- In the elderly, 30–40% of cases are associated with the initial presentation of diabetes
Pediatric Considerations
Hyperosmolar hyperglycemic states (HHS) rare in pediatric patients
Etiology
Etiology
- Hyperosmolar state precipitated by factors that:
- Impair peripheral insulin action
- Increase endogenous or exogenous glucose
- Decrease patient's ability to replace fluid loss
- Infection (esp pneumonia and UTI) most common precipitating factor
- Other precipitating causes include:
- Inadequate therapy/medication omission
- Sepsis
- Medications/drugs:
- Diuretics
- β-blockers
- Calcium channel blockers
- Atypical antipsychotics
- Corticosteroids
- Sympathomimetics
- Phenytoin
- Cimetidine
- Amphetamines
- Ethanol
- Myocardial infarction
- CVA
- Renal failure
- Heat stroke
- Pancreatitis
- Appendicitis
- Intestinal obstruction
- Endocrine disorders
- Pregnancy
- Trauma
- Burns
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Citation
Schaider, Jeffrey J., et al., editors. "Hyperosmolar Syndrome." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307538/all/Hyperosmolar_Syndrome.
Hyperosmolar Syndrome. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307538/all/Hyperosmolar_Syndrome. Accessed November 4, 2024.
Hyperosmolar Syndrome. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307538/all/Hyperosmolar_Syndrome
Hyperosmolar Syndrome [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 November 04]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307538/all/Hyperosmolar_Syndrome.
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