Hyperosmolar hyperglycemic state
Hyperosmolar hyperglycemic state occurs primarily in people with type 2 diabetes. This state is characterized by hyperglycemia often greater than 30 mmol/L, and severe dehydration.
During a hyperglycemic episode, the accumulation of glucose in the blood increases the frequency and volume of urination. This can cause excessive water loss and significant dehydration. This can be followed by a drop in blood pressure leading to decreased consciousness and eventually to coma if the HHS is left untreated.
Lack of insulin is the cause. However, contrary to diabetic ketoacidosis, in HHS there is normally no significant presence of ketones in the blood or urine because insulin is not totally absent.
The symptoms are typical of hyperglycemia, including frequent and abundant urination, intense thirst and exhaustion, as well as such signs of dehydration as dry mouth, sunken eyes, dry skin, etc.
People with kidney problems are more susceptible to HHS because their kidneys are less efficient in eliminating excess glucose in the blood when hyperglycemic.
The elderly are less aware of their own thirst, so are consequently more at risk.