Curriculum · Metabolic and Endocrine and Diabetes Mellitus
Hyperglycaemic hyperosmolar state (HHS/HONK) in primary care
What it is
Hyperglycemic Hyperosmolar State (HHS), also written Hyperglycemic Hyperosmolar non- Ketotic state/coma (HONK). The second half of that name carries the point: the blood glucose is very high, and the test for ketones is negative or only mild positive.
How it presents
Suspect this condition if the patient has signs and symptoms of severe hyperglycemia (blood glucose 33 mmol/l or more), drowsiness, severe dehydration and with negative or mild positive test for ketones. It is the ketone line that does the work here: the blood glucose is at 33 mmol/l or more and the test for ketones is still negative or only mild positive.