THE HYPERGLYCEMIC HYPEROSMOLAR SYNDROME: HISTORY AND ESSENTIAL CLINICAL INSIGHTS

Ignacy Maciejewski; Sebastian Iwaniuk; Jakub Skiba; Zuzanna Skiba; Kinga Tylczyńska; Natalia Tylczyńska; Kinga Kowalik; Maria Michalska; Aleksandra Zielińska; Szymon Szypulski

doi:10.31435/ijitss.3(47).2025.3783

Ignacy Maciejewski 5th Military Clinical Hospital in Cracow, Wrocławska 1/3, 30-901 Cracow, Poland https://orcid.org/0000-0002-0424-9095
Sebastian Iwaniuk University Clinical Centre of the Medical University of Warsaw, ul. Banacha 1A, 02-097 Warsaw, Poland https://orcid.org/0009-0000-9125-6172
Jakub Skiba Independent Public Health Care Facility in Koło, Księcia Józefa Poniatowskiego 25, 62-600 Koło, Poland https://orcid.org/0009-0002-2451-6477
Zuzanna Skiba Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0001-7583-5868
Kinga Tylczyńska Cardinal Stefan Wyszynski University in Warsaw, Kazimierza Wóycickiego 1/3, 01-938 Warsaw, Poland https://orcid.org/0009-0008-1820-3013
Natalia Tylczyńska Cardinal Stefan Wyszynski University in Warsaw, Kazimierza Wóycickiego 1/3, 01-938 Warsaw, Poland https://orcid.org/0009-0002-8668-0272
Kinga Kowalik Wolski Hospital, Marcina Kasprzaka 17, 01-211 Warsaw, Poland https://orcid.org/0009-0000-4894-6987
Maria Michalska Wolski Hospital, Marcina Kasprzaka 17, 01-211 Warsaw, Poland https://orcid.org/0009-0004-7822-8299
Aleksandra Zielińska Praski Hospital in Warsaw, al. „Solidarności” 67, 03-401 Warsaw, Poland https://orcid.org/0009-0007-4791-9160
Szymon Szypulski Infant Jesus Teaching Hospital, Williama Heerleina Lindleya 4, 02-005 Warsaw, Poland https://orcid.org/0009-0008-7228-7086

DOI: https://doi.org/10.31435/ijitss.3(47).2025.3783

Keywords: Diabetes, Hyperglycemic Hyperosmolar Syndrome

Abstract

Hyperglycemic hyperosmolar state (HHS) is one of the most severe acute complications of diabetes mellitus. It is characterized by profound hyperglycemia, absence of ketoacidosis, and altered mental status. With a mortality rate that may reach up to 20%, HHS remains a critical but often underrecognized clinical entity. Historically marginalized due to its relative rarity and poorly understood pathophysiology, its clinical relevance is increasing in parallel with lifestyle changes and the global rise in type 2 diabetes prevalence.

The aim of this article was to compile key information on the history, pathophysiology, and management of HHS in order to raise awareness among all healthcare professionals involved in the care of patients with diabetes. Early recognition of HHS is essential to initiate timely treatment and improve patient outcomes.

Classic symptoms such as excessive thirst with accompanying polyuria and altered mental status particularly in patients with seemingly mild infections or those with chronic but untreated or poorly controlled diabetes - should prompt increased vigilance among medical staff.

Rapid diagnostic evaluation and prompt initiation of treatment must be prioritized in emergency settings to reduce morbidity and mortality associated with this life-threatening condition.

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