Hyperosmolar Hyperglycemic State (previously known as “Hyperosmolar Hyperglycemic Nonketotic Syndrome” and, before that, “Hyperosmolar Hyperglycemic Nonketotic Coma”) is a bit of a slippery animal. Despite being redefined several times, the precise definition remains elusive. This may cause it to be over-diagnosed in anyone with severe hyperglycemia. The treatment likewise remains a bit controversial, with different guidelines recommending opposing strategies. Consequently, we may need to rely on a sound understanding of the physiology and some common sense to navigate the confusion of this diagnosis.
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