Case challenge · Endocrinology / Emergency / Critical care · teaching

Hyperosmolar Hyperglycemic State (HHS) — Management Pathway · case challenge

Given a case, work through the care pathway step by step; the tool checks each choice and scores you. Decisions and basis are taken from this site's reviewed care pathways.

← View the full flowchartBased on 2024 ADA/EASD

Case #1Endocrinology / Emergency / Critical care

📋 Case data

HHS diagnosis (four criteria)More like DKA or mixed

Data is taken from this pathway's reviewed node text. Work through the pathway step by step.

Step 1 / 1 · HHS diagnosis (four criteria)

Does it meet the HHS diagnostic criteria?

💡 Four HHS criteria: 1) glucose ≥33.3 mmol/L (600 mg/dL); 2) effective serum osmolality >320 mOsm/kg (effective osm = 2×Na + glucose in mmol/L); 3) no significant ketosis (β-hydroxybutyrate <3.0 mmol/L or urine ketones ≤2+); 4) no acidosis (pH ≥7.3, HCO3 ≥15 mmol/L). The degree of altered consciousness correlates with osmolality.

For teaching. Decisions and their basis are taken from this site's reviewed care pathways; for licensed clinicians/trainees, this does not replace clinical judgment or local protocols.