Differential Diagnosis for HHS (Hyperosmolar Hyperglycemic State)
- Single most likely diagnosis:
- Diabetic Ketoacidosis (DKA) - Although HHS is a distinct entity, DKA and HHS can present similarly, and the presence of significant hyperglycemia and dehydration in HHS might initially suggest DKA, especially if ketosis is not immediately ruled out.
- Other Likely diagnoses:
- Dehydration - Severe dehydration can lead to hyperosmolarity, and while not a diagnosis in itself, it's a critical component of HHS, often resulting from other underlying conditions.
- Sepsis - Infections can precipitate HHS, especially in patients with diabetes, by increasing glucose levels and causing dehydration.
- Acute Kidney Injury (AKI) - AKI can lead to the accumulation of glucose and urea, contributing to hyperosmolarity.
- Do Not Miss diagnoses:
- Stroke or other CNS disorders - These can cause hyperglycemia and may be precipitated by or contribute to the development of HHS.
- Myocardial Infarction - Can be precipitated by or contribute to HHS due to stress response and potential for dehydration.
- Infections (specifically, those that might not be immediately apparent, like pneumonia or urinary tract infections) - These can precipitate HHS and have a high mortality if not treated promptly.
- Rare diagnoses:
- Pancreatitis - Though more commonly associated with DKA, pancreatitis can also precipitate HHS, especially if there's significant hypertriglyceridemia.
- Hyperaldosteronism - A rare cause of hypertension and hypokalemia, which can contribute to dehydration and potentially HHS in diabetic patients.
- Pheochromocytoma - Can cause hyperglycemia due to excess catecholamines and potentially lead to HHS, though this is exceedingly rare.