Though less common, HHS has a mortality rate that is 10x greater than DKA.
The hallmark features of HHS include severe hyperglycemia (> 600 mg/dL), hyperosmolality (> 320 mOsm/kg), minimal to no ketosis, and severe dehydration.
Though the management of HHS is similar to DKA and includes fluid resuscitation, correction of hyperglycemia, and correction of electrolyte abnormalities, it is important to also monitor serum osmolality.
Too rapid correction of serum osmolality can cause cerebral edema and worsen patient outcomes.
Current recommendations are to monitor serum osmolality every 1-2 hours with a correction of no more than 3 mOsm/kg/hr.
Long B, Willis GC, Lentz S, et al. Diangosis and management of the critically ill adult patient with hyperglycemic hyperosmolar state. J Emerg Med. 2021;61:365-75.