Hyperosmolar Hyperglycemic State

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Endocrine Clinical reference

Hyperosmolar Hyperglycemic State

HHS (formerly HONK): severe hyperglycemia (>600 mg/dL), hyperosmolarity (>320 mOsm/kg), minimal ketosis, profound dehydration. Predominantly T2DM elderly. Higher mortality than DKA.

HHS HONK hyperosmolar hyperglycemic state hyperosmolar nonketotic coma
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Common tests

Tests performed

Glucose (>600) Serum osmolality (>320) BMP (no significant acidosis) CBC Urinalysis Blood cultures ECG
Common medications

Recognize the drug and the class

Aggressive IV fluids (0.9% NS then 0.45% NS — goal 5-10L over 24h) Low-dose insulin infusion (after fluids started) Potassium replacement DVT prophylaxis
Related nursing diagnoses

NANDA diagnoses & care plans

Use these direct links to open nursing diagnoses and care-plan support related to Hyperosmolar Hyperglycemic State.

Deficient Fluid Volume Unstable Blood Glucose Level Risk for Injury Impaired Physical Mobility