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Hyperosmolar Hyperglycemic State


Hyperosmolar hyperglycemic state (HHS) is a serious medical condition that develops if your blood sugar levels get very high. Your body gets rid of the extra sugar through your urine. This leads to severe dehydration. HHS can occur in people with type 1 or type 2 diabetes, but is more common in people with 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.


Your weight may be measured each day to monitor the amount of fluid in your body. Healthcare providers compare your weight from day to day to record how much body fluid you have. You may also need any of the following:

  • Intake and output may be measured. Healthcare providers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask healthcare providers if they need to measure or collect your urine.
  • A heart monitor is an EKG that stays on continuously to record your heart's electrical activity.
  • 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.


Insulin decreases the amount of sugar in your blood. You may need to take insulin until your blood sugar level becomes normal.


  • Blood and urine tests will be done. They will be done to check your glucose, ketone, and electrolyte levels. They will also show if you are dehydrated or have an infection.
  • An EKG test records your heart rhythm and how fast your heart beats.
  • A chest x-ray may show signs of infection.


  • IV fluids are given to treat your dehydration. The liquids may also include electrolytes, such as potassium and sodium.
  • Other treatments may be needed for conditions that led to HHS. If you are using medicines that put you at risk for HHS, they may need to be changed or stopped.

Diabetes education:

Healthcare providers will teach you how to manage your diabetes. A healthcare provider may also visit you at home to teach you more about diabetes, or you may attend classes. They will teach you what to do if your blood sugar level goes too high or too low. They will also help you plan sick day management.


Treatment with insulin may cause your blood sugar level to become too low. IV fluid replacement may cause fluid to build up in your lungs and cause trouble breathing. Fluid replacement may also cause cerebral edema (fluid buildup around the brain), which 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 healthcare providers to decide what care you want to receive. You always have the right to refuse treatment.

© Copyright IBM Corporation 2021 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 IBM Watson Health

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.

Learn more about Hyperosmolar Hyperglycemic State (Inpatient Care)

Associated drugs

IBM Watson Micromedex

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.