Hyperosmolar hyperglycemic state physical examination

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

Patients with the hyperosmolar hyperglycemic state may usually appear dehydrated, lethargic, disoriented and in shock. Physical examination of patients with the hyperosmolar hyperglycemic state is usually remarkable for hypothermia, hypotension, tachycardia, tachypnea, nausea, vomiting and seizures or other focal neurological signs.

Patient may look dehydrated, ill-appearing, diaphoretic, disoriented or obtunded due to severe hyperglycemia and hyperosmolality.^[1]

• Hypothermia^[2]
• Hypotension^[3]
• Tachycardia^[3]
• Tachypnea^[4]
• Weak pulses due to dehydration

• Poor skin turgor due to dehydration
• Cutaneous infection (non-healing ulcer)^[5]
• Xerosis^[5]
• Hair loss^[5]
• Acanthosis nigricans in type 2 diabetics^[6]
• Diabetic dermopathy (small <1 cm, well-demarcated, atrophic depressions, macules, or papules on the pretibial region) in type 2 diabetics^[7]
• Eruptive xanthomas in type 2 diabetics^[8][5]
• Necrobiosis lipoidica (irregular, painless ovoid plaques with a yellow atrophic center and a red to purple periphery)^[5]
• Vitiligo^[5]
• Diabetic bullae^[9][5]

• Extra-ocular movements may be abnormal due to the involvement of third, fourth, sixth, and seventh cranial nerves affecting ocular movements.^[10]
• Ophthalmoscopic exam may be abnormal with findings of diabetic retinopathy.
• Hearing acuity may be reduced.
• Sunken eyes due to dehydration.

• Not significant

• Rales/crackles due to pulmonary edema (in case of treatmnet complication) or pneumonia (in cases where infection is a precipitating cause)^[11]

• S1 normal
• S2 normal
• U wave (hypokalemia)^[12]
• Cardiac arrhythmia (Atrial fibrillation and ventricular arrhythmia)^[13]

• Nausea
• Vomiting

• Not significant

• Polyuria^[3]

• Irritability
• Restlessness
• Stupor
• Muscular twitching
• Hyperreflexia
• Lethargy
• Spasticity
• Seizures^[14]
• Coma

• Muscle cramping^[15]
• Cold extremities^[3]

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