Hyperosmolar hyperglycemic state laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

Overview

Laboratory findings consistent with the diagnosis of hyperosmolar hyperglycemic state (HHS) include plasma glucose > 600 mg/dl, serum osmolarity > 320 mOsm/kg, blood pH > 7.3, serum bicarbonate > 18 mEq/L and negative or trace positive urine or serum ketones.

Laboratory Findings

The following lab abnormalities may be found in hyperosmolar hyperglycemic state (HHS):^[1]^[2]^[3]^[4]^[5]^[6]^[7]

LAB	FORMULA/ VARIABLE	NORMAL VALUE	VALUE IN HHS
Plasma glucose (mg/dL)	Direct measurement	< 200 mg/dl	> 600 mg/dl
Arterial pH	Blood pH	7.35-7.45	> 7.30
Anion gap	(Na⁺) – (Cl^– + HCO3^–)	7 to 13 (mEq/L)	Variable
Serum osmolality	2(Na + K) + (glucose/18) + (blood urea nitrogen/2.8)	285 to 295 mOsm/kg (285 to 295 mmol/kg) of water	Increased (> 320mOsm/kg)
Plasma ketones	Direct measurement	Negative	Trace or negative
Urine ketones	Direct measurement	Negative	Trace or negative
Serum bicarbonate	Direct measurement	23 – 29 mEq/L	> 18 mEq/L
Blood urea nitrogen (BUN), creatinine levels	N/A	BUN: 7-20 mg/dl Creatinine levels: 0.8-1.2mg/dl	Increased (Dehydration and decreased renal perfusion)

References

↑ Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). “Hyperglycemic crises in adult patients with diabetes”. Diabetes Care. 32 (7): 1335–43. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.
↑ Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JM, Fournier H, Havrankova J (2003). “Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state”. CMAJ. 168 (7): 859–66. PMC 151994. PMID 12668546.
↑ Liamis G, Liberopoulos E, Barkas F, Elisaf M (2014). “Diabetes mellitus and electrolyte disorders”. World J Clin Cases. 2 (10): 488–96. doi:10.12998/wjcc.v2.i10.488. PMC 4198400. PMID 25325058.
↑ Adrogué HJ, Lederer ED, Suki WN, Eknoyan G (1986). “Determinants of plasma potassium levels in diabetic ketoacidosis”. Medicine (Baltimore). 65 (3): 163–72. PMID 3084904.
↑ Xu W, Wu HF, Ma SG, Bai F, Hu W, Jin Y, Liu H (2013). “Correlation between peripheral white blood cell counts and hyperglycemic emergencies”. Int J Med Sci. 10 (6): 758–65. doi:10.7150/ijms.6155. PMC 3638300. PMID 23630441.
↑ Molitch ME, Rodman E, Hirsch CA, Dubinsky E (1980). “Spurious serum creatinine elevations in ketoacidosis”. Ann. Intern. Med. 93 (2): 280–1. PMID 6773457.
↑ Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G (2000). “Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room”. Am. J. Nephrol. 20 (4): 319–23. doi:10.1159/000013607. PMID 10970986.

Template:WH Template:WS

[pmid19564476-1] Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). “Hyperglycemic crises in adult patients with diabetes”. Diabetes Care. 32 (7): 1335–43. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.

[pmid12668546-2] Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JM, Fournier H, Havrankova J (2003). “Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state”. CMAJ. 168 (7): 859–66. PMC 151994. PMID 12668546.

[pmid25325058-3] Liamis G, Liberopoulos E, Barkas F, Elisaf M (2014). “Diabetes mellitus and electrolyte disorders”. World J Clin Cases. 2 (10): 488–96. doi:10.12998/wjcc.v2.i10.488. PMC 4198400. PMID 25325058.

[pmid3084904-4] Adrogué HJ, Lederer ED, Suki WN, Eknoyan G (1986). “Determinants of plasma potassium levels in diabetic ketoacidosis”. Medicine (Baltimore). 65 (3): 163–72. PMID 3084904.

[pmid23630441-5] Xu W, Wu HF, Ma SG, Bai F, Hu W, Jin Y, Liu H (2013). “Correlation between peripheral white blood cell counts and hyperglycemic emergencies”. Int J Med Sci. 10 (6): 758–65. doi:10.7150/ijms.6155. PMC 3638300. PMID 23630441.

[pmid6773457-6] Molitch ME, Rodman E, Hirsch CA, Dubinsky E (1980). “Spurious serum creatinine elevations in ketoacidosis”. Ann. Intern. Med. 93 (2): 280–1. PMID 6773457.

[pmid10970986-7] Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G (2000). “Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room”. Am. J. Nephrol. 20 (4): 319–23. doi:10.1159/000013607. PMID 10970986.

[1]

[2]

[3]

[4]

[5]

[6]

[7]