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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Hyperosmolar hyperglycemic state laboratory findings

Introduction

Overview

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

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
  • 7.35-7.45
  • > 7.30
Anion gap
  • (Na+) – (Cl– + HCO3–)
  • 7 to 13 (mEq/L)
  • Variable
Serum osmolality
  • 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
References

References

  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.
  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.
  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.
  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.
  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.
  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.
  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.

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