Cao Siyuan, Yadav Bijay, Huo Lihong, Bagdasaryan Robert, Cao Shanjin
Pulmonary and Critical Care Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California.
Hospital Medicine, Department of Internal Medicine, St. Anne's Hospital, Prima CARE, P.C., Fall River, Massachusetts.
J Emerg Med. 2025 May;72:25-30. doi: 10.1016/j.jemermed.2024.12.001. Epub 2024 Dec 30.
Hyperosmolar hyperglycemic state (HHS) is a serious and potentially life-threatening complication of diabetes, defined by serum glucose >600 mg/dL and effective osmolality >320 mOsm/kg. However, some patients present with hyperglycemia (serum glucose levels ≥180 mg/dL but <600 mg/dL), hypernatremia, and effective osmolality >320 mOsm/kg. We refer to this subtype of HHS as euglycemic hyperosmolar hypernatremic state.
We aimed to investigate its clinical characteristics compared to traditional HHS.
A retrospective observational study of consecutive adult patients with diabetes and effective osmolality >320 mOsm/kg admitted between January 2021 and February 2023 in a single medical institution. The study analyzed age, sex, hemoglobin A1c (HbA1c), serum glucose, serum sodium, effective osmolality, and mortality of encounters of euglycemic hyperosmolar hypernatremic state and traditional HHS.
We encountered 34 cases of euglycemic hyperosmolar hypernatremic state and 19 cases of traditional HHS. Patients with euglycemic hyperosmolar hypernatremic state were older, had less severe diabetes with lower baseline HbA1c, worse hypernatremia, lower effective osmolality, and higher mortality (35.3 % vs. 0 %; p = 0.002) compared to patients with traditional HHS. Euglycemic hyperosmolar hypernatremic state had a similarly high mortality rate as hypernatremia alone.
Euglycemic hyperosmolar hypernatremic state is a variant subtype of HHS. It shares the same pathophysiological mechanisms as traditional HHS but is associated with higher mortality, thus warranting increased recognition as it requires similar treatment strategy as traditional HHS.
高渗高血糖状态（HHS）是糖尿病一种严重且可能危及生命的并发症，定义为血清葡萄糖>600mg/dL且有效渗透压>320mOsm/kg。然而，一些患者表现为血糖升高（血清葡萄糖水平≥180mg/dL但<600mg/dL）、高钠血症且有效渗透压>320mOsm/kg。我们将这种HHS亚型称为正常血糖性高渗高钠状态。
我们旨在研究其与传统HHS相比的临床特征。
对2021年1月至2023年2月期间在单一医疗机构收治的连续成年糖尿病患者且有效渗透压>320mOsm/kg进行回顾性观察研究。该研究分析了正常血糖性高渗高钠状态和传统HHS患者的年龄、性别、糖化血红蛋白（HbA1c）、血清葡萄糖、血清钠、有效渗透压和死亡率。
我们遇到34例正常血糖性高渗高钠状态患者和19例传统HHS患者。与传统HHS患者相比，正常血糖性高渗高钠状态患者年龄更大，糖尿病病情较轻，基线HbA1c较低，高钠血症更严重，有效渗透压较低，死亡率更高（35.3%对0%；p = 0.002）。正常血糖性高渗高钠状态的死亡率与单纯高钠血症相似。
正常血糖性高渗高钠状态是HHS的一种变异亚型。它与传统HHS具有相同的病理生理机制，但死亡率更高，因此鉴于其需要与传统HHS相似的治疗策略，应提高对其的认识。
