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Hyperglycemic Hyperosmolar State (HHS)

Writer: MaytaMayta
Sep 15, 20241 min read

1. Diagnostic Criteria for HHS

  • Serum Glucose: > 600 mg/dL

  • Serum Osmolality: > 320 mOsm/kg

  • pH > 7.3

  • Bicarbonate > 15 mmol/L

  • Minimal or no ketonemia/ketonuria

2. Initial Management of HHS

A. Fluid Resuscitation

  • Initial Bolus: 0.9% NaCl, 10-20 mL/kg over 1-2 hours.

  • Deficit Replacement: 0.45-0.75% NaCl, with the goal of correcting dehydration over 24-48 hours.

B. Insulin Therapy

  • Begin when blood glucose reduction plateaus with fluids.

  • Low-Dose Insulin Infusion: 0.025-0.05 units/kg/hour.

  • Avoid bolus insulin to prevent rapid osmolar shifts.

C. Electrolyte Management

  • Potassium Replacement: As for DKA, based on serum potassium levels.

  • Phosphate Replacement: Only in cases of severe hypophosphatemia.

3. Monitoring and Complications

  • Close monitoring of blood glucose and electrolytes.

  • Watch for rhabdomyolysis or acute kidney injury.

 
 
 

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Post: Blog2_Post

Message for International Readers
Understanding My Medical Context in Thailand

By Uniqcret, M.D.
 

Dear readers,
 

My name is Uniqcret, which is my pen name used in all my medical writings. I am a Doctor of Medicine trained and currently practicing in Thailand, a developing country in Southeast Asia.
 

The medical training environment in Thailand is vastly different from that of Western countries. Our education system heavily emphasizes rote memorization—those who excel are often seen as "walking encyclopedias." Unfortunately, those who question, critically analyze, or solve problems efficiently may sometimes be overlooked, despite having exceptional clinical thinking skills.
 

One key difference is in patient access. In Thailand, patients can walk directly into tertiary care centers without going through a referral system or primary care gatekeeping. This creates an intense clinical workload for doctors and trainees alike. From the age of 20, I was already seeing real patients, performing procedures, and assisting in operations—not in simulations, but in live clinical situations. Long work hours, sometimes exceeding 48 hours without sleep, are considered normal for young doctors here.
 

Many of the insights I share are based on first-hand experiences, feedback from attending physicians, and real clinical practice. In our culture, teaching often involves intense feedback—what we call "โดนซอย" (being sliced). While this may seem harsh, it pushes us to grow stronger, think faster, and become more capable under pressure. You could say our motto is “no pain, no gain.”
 

Please be aware that while my articles may contain clinically accurate insights, they are not always suitable as direct references for academic papers, as some content is generated through AI support based on my knowledge and clinical exposure. If you wish to use the content for academic or clinical reference, I strongly recommend cross-verifying it with high-quality sources or databases. You may even copy sections of my articles into AI tools or search engines to find original sources for further reading.
 

I believe that my knowledge—built from real clinical experience in a high-intensity, under-resourced healthcare system—can offer valuable perspectives that are hard to find in textbooks. Whether you're a student, clinician, or educator, I hope my content adds insight and value to your journey.
 

With respect and solidarity,

Uniqcret, M.D.

Physician | Educator | Writer
Thailand

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