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Hyperosmolar Hyperglycemic State

  • Cynthia M. Johnson, MA
Publication Type:


Hyperosmolar Hyperglycemic State

(HHS; Hyperosmolar Nonketotic Coma; HHNC)


Hyperosmolar hyperglycemic state (HHS) is when a person with diabetes has very high blood glucose levels and loses too much fluid. It can be deadly without treatment.


HHS happens when there is too much glucose in the blood. The body tries to fix this by passing extra glucose out in the urine. If too much water is passed out of the body as urine, then it can be hard for the heart and brain to work.

It can be triggered by:
  • Poorly controlled diabetes
  • Infection
  • Illnesses, such as pancreatitis
  • Heart attack or Stroke
  • Trauma
  • Kidney failure
  • Certain medicines, such as diuretics and steroids
  • Recent surgery

Risk Factors

HHS can happen at any age, but it is more common in older adults and people with type 2 diabetes. It is also more common in people who are Black, Native American, and Hispanic.


Common symptoms are:

  • Dry mouth and severe thirst
  • Passing urine (pee) more often
  • Confusion
  • Seizures
  • Sleepiness
  • Changes in vision
  • Seeing or hearing things that are not there
  • Weakness


The doctor will ask about symptoms and past health. A physical exam will be done.

Blood tests will be done to measure blood glucose levels and check for signs of infection. Urine tests will be done to find out if the body is burning fat for energy. This may happen when there is not enough glucose in the body. Urine tests can also check for signs of infection.

The electrical activity of the heart may be tested. This can be done with an EKG.


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Emergency medical care will be needed. The goal of treatment is put the fluids and minerals a person has lost back into their body to ease symptoms. Glucose will also be put back to the right level. This can be done through an IV.

Other treatment may be needed if there is an infection.


The risk of this health problem can be lowered by:

  • Managing diabetes
  • Eating a healthful diet and drinking plenty of fluids
  • Seeking care for illnesses or signs of infection




  • Hyperglycemic hyperosmolar state in adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/hyperglycemic-hyperosmolar-state-in-adults.
  • Hyperglycemic hyperosmolar state in children. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/hyperglycemic-hyperosmolar-state-in-children.
  • Stoner, G. Hyperosmolar hyperglycemic state. American Family Physician, 2017; 96(11): 729-736. Available at: https://www.aafp.org/afp/2017/1201/p729.html.


  • Mark S. Itzkowitz, MD, JD
Last Updated:

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.