2. Estado Hiperosmolar Hiperglucémico (EHH)
“ Hiperglucemia (glucosa sérica >600mg/dl) e
hiperosmolaridad (>320mOsm/L) en ausencia de
cetonemia significativa y acidosis ”

3. Estado Hiperosmolar Hiperglucémico (EHH)
 Estado Hiperosmolar no cetósico
 Coma Hiperosmolar

4. Estado Hiperosmolar Hiperglucémico (EHH)
 Frecuencia DM2 > DM1.
 Edad media 65 años
 Debutan con EHH 30-40%.
 < 1% de admisiones por DM.
 Mortalidad de al menos 10%.
 Cetosis moderada es comun
 Coma <30%.

5. Fisiopatología de EHH
 Deficiencia de insulina y aumento de hormonas
contrarreguladoras.

6. Diagnóstico EHH
 Criterios diagnósticos EHH :
a. Glucosa sérica >600 mg/dl
b. pH arterial >7.3
c. bicarbonato sérico >15 mEq/l
d. and mínima cetonuria and cetonemia.

7. Table 203.1 Diagnostic Criteria for DKA and HHS
DKA
Mild Moderate Severe HHS
Diagnostic criteria and
classification
Plasma glucose (mg/dL) >250 >250 mg/dL >250 mg/dL >600 mg/dL
mg/dL
Arterial pH 7.25– 7.00 to <7.25 <7.00 >7.30
7.30
Serum bicarbonate (mEq/L) 15–18 10 to <15 <10 >15
Urine ketonea Positive Positive Positive Small
Serum ketonea Positive Positive Positive Small
Effective serum osmolalityb Variable Variable Variable >320 mOsm/kg
Anion gapc >10 >12 >12 <12
Mental status Alert Alert/drowsy Stupor/coma Stupor/coma
DKA, diabetic ketoacidosis; HHS, hyperosmolar hyperglycemic state.
aNitroprusside reaction method.
bCalculation of effective serum osmolality: 2[measured Na+ (mEq/L)] + [glucose (mg/dL)]/18.
cCalculation of anion gap: (Na+) - [Cl- + HCO - (mEq/L)].
3
Source: Modified from Kitabchi AE, Umpierrez GE, Murphy MB, et al. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes
Association. Diabetes Care 2006;29:2739–2748.

8. EVALUACION EHH
 ABC
 Historial de DM otras comorbilidades.
 Laboratorio.
 Gabinete.

9. Table 203.3 Typical admission biochemical data in patients who have hyperglycemic
hyperosmolar syndrome and diabetic ketoacidosis
Laboratory Test HHS DKA
Glucose (mg/dL) 930 ± 83 616 ± 36
Na+ (mEq/L) 149 ± 3.2 134 ± 1.0
K+ (mEq/L) 3.9 ± 0.2 4.5 ± 0.13
BUN (mg/dL) 61 ± 11 32 ± 3
Creatinine (mg/dL) 1.4 ± 0.1 1.1 ± 0.1
pH 7.3 ± 0.03 7.12 ± 0.04
Bicarbonate (mEq/L) 18 ± 1.1 9.4 ± 1.4
BOHB (mmol/L) 1.0 ± 0.2 9.1 ± 0.85
Total osmolality (mOsm/kg) 380 ± 5.7 323 ± 2.5
Anion gap 11 17
Data are presented as mean ± SEM.
Abbreviation: IRI, immuno reactive insulin, HHS, hyperglycemic hyperosmolar syndrome, DKA, diabetic ketoacidosis.
Adapted from Kitabchi AE, Umpierrez GE, Murphy MB, et al. Management of hyperglycemic crises in patients with diabetes. Diabetes Care 2001;24:131–53.

10. Type of Deficit HHS DKA
Total water (l) 9 6
Water (mL/kg) 100–200 100
Na+ (mEq/kg) 5–13 7–10
Cl- (mEq/kg) 5–15 3–5
K+ (mEq/kg) 4–6 3–5
PO4 (mmol/kg) 3–7 5–7
Mg++ (mEq/kg) 1–2 1–2
Ca++ (mEq/kg) 1–2 1–2
Adapted from Ennis ED, Stahl EJVB, Kreisberg RA. The hyperosmolar hyperglycemic syndrome. Diabetes Rev 1994;2:115–126. and Kreisberg
RA: Diabetic ketoacidosis: an update. Crit Care Clin 1987;3:817–834.

14. Resolucion EHH
Paciente alerta
Osmolaridad plasmática es < 315 mosmol/kg.
El paciente es capaz de comer.