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Hyperosmolar Hyperglycemic State


Hyperosmolar hyperglycemic state (HHS) is a serious medical condition that develops if you have diabetes and your blood sugar levels get very high. Your body gets rid of the extra sugar through your urine. This leads to severe dehydration. You can develop HHS at any age and whether you have type 1 or type 2 diabetes.


Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

You may need extra oxygen

if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your healthcare provider before you take off the mask or oxygen tubing.


A dietitian may work with you to find a meal plan that will help you control your blood sugar. Ask caregivers how your favorite foods may fit into this meal plan.


  • Weight: You may be weighed each day. Caregivers compare your weight from day to day to record how much body fluid you have. You can become dehydrated if you lose too much. You can have shortness of breath or swelling in your legs if you retain too much.
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  • Intake and output: Your healthcare provider may need to know how much liquid you are getting and urinating. You may need to urinate into a container in bed, or in the toilet. A healthcare provider will then measure the amount you urinated. Do not flush urine down the toilet before you ask your healthcare provider.
  • A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine.
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.


  • Blood gases: This is also called an arterial blood gas, or ABG. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. Your blood is tested for the amount of oxygen and carbon dioxide in it. The results can tell caregivers how well your lungs are working.
  • Blood glucose tests: Your blood sugar level may be checked many times each day. This is usually done before meals and at bedtime. Your blood is put into a glucose meter.
  • Blood tests: Your blood may be tested for ketones, sugar, electrolyte (body salts) levels, and signs of infection. You may need to have blood drawn more than once.
  • Telemetry is continuous monitoring of your heart rhythm. Sticky pads placed on your skin connect to an EKG machine that records your heart rhythm.
  • Urine test: This test is used to check for sugar, ketones, or signs of a urinary tract infection.
  • Chest x-ray: This is a picture of your lungs and heart. Healthcare providers may use the x-ray to look for signs of infection, such as pneumonia.


  • IV fluids: You may receive liquids through a tube that is placed in your vein to treat your dehydration. The liquids may also include electrolytes, such as potassium.
  • Insulin: This medicine may be given to decrease the amount of sugar in your blood. It helps your body move the sugar to your cells, where it is needed for energy.
  • Other treatments: Healthcare providers may also treat other conditions that led to HHS. If you are using medicines that put you at risk for HHS, they may have to be changed or stopped.


Treatment may cause your blood sugar level to become too low. Very low blood sugar levels may cause seizures, or you may become unconscious. IV fluid replacement may cause trouble breathing from fluid buildup. Fluids may also cause cerebral edema (fluid buildup around the brain), which can be life-threatening. Without treatment, high blood sugar levels can lead to severe dehydration. Other serious medical problems, such as seizures or a coma, can also develop. HHS can be life-threatening.


You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

© 2017 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.