Patient handout

Hyperosmolar hyperglycemic state (adult)

PRODUCTION

1. Your condition

This handout is for hyperosmolar hyperglycemic state (adult). Your care team identified this based on: glucose ≥600 mg/dl (ada 2026 §16; kitabchi 2009).

Other reasons your team may use this plan: ams in elderly diabetic (jbds-ip 2023; scott 2015 uk audit); effective osmolality >300 mosm/kg without ketoacidosis (ada/easd 2024 consensus); known t2dm + dehydration / infection trigger (pasquel 2014; jbds-ip 2023).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
0.9% sodium chloride	1 L IV over 1h (no bolus); aim positive balance 3–6 L by 12h, 6–9 L by 24h (JBDS-IP 2023)	IV	continuous	JBDS-IP 06 (2nd ed 2023) — fluids alone often drop glucose by 50–100 mg/dL/h and reduce osmolality before any insulin (Kitabchi 2009)

Plan: HHS acute — JBDS-IP 06 (2nd ed 2023) fluid-first + delayed low-dose insulin

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Effective osmolality >350 mOsm/kg with coma or seizure (ADA/EASD 2024 consensus; JBDS-IP 2023)(life-threatening)
K <3.3 mEq/L on initial labs (ADA 2026 §16; Kitabchi 2009)
Effective osmolality falling >8 mOsm/kg/h OR glucose >90 mg/dL/h (JBDS-IP 2023)
Glucose ≥600 + osm >320 + BHB ≥3.0 + pH <7.30 (ADA/EASD 2024 consensus)
qSOFA ≥2 (RR ≥22, SBP ≤100, AMS) at presentation (Sepsis-3 2016)
New ECG/troponin abnormality OR focal neuro deficit (JBDS-IP 2023; Pasquel 2014)
Calculated free-water deficit >10 mL/kg with effective osmolality >340 mOsm/kg (JBDS-IP 2023; Kitabchi 2009)
Corrected sodium rising above 150 mEq/L despite NS resuscitation (JBDS-IP 2023; Adrogué-Madias NEJM 2000)

5. Follow-up

Endo + diabetes education; review precipitant; revise outpatient T2DM regimen per ADA 2026 §9 cardiorenal-first (SGLT2i/GLP-1 RA); medication reconciliation removing precipitating drugs (Beers 2023)

6. Sources

Guideline: 2024 ADA/EASD/JBDS/AACE/DTS Hyperglycemic Crises Consensus + ADA SoC 2026 Ch 16 (Diabetes Care in the Hospital) + JBDS-IP 06 (2nd ed 2022, 2023 update) + KDIGO 2024 CKD (AKI staging) + 2025 AHA/ACC HTN (post-resolution BP)