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Diagnostic criteria

Last reviewed Jun 5, 2022

Authoring team

diagnostic criteria for hyperglycemic hyperosmolar state

The following diagnostic criteria have been recommended:

plasma glucose concentration >33.3 mmol/L (600 mg/dL)
arterial pH > 7.30; venous pH > 7.25
serum bicarbonate >15 mmol/L
small ketonuria, absent to small ketonemia
effective serum osmolality >320 mOsm/kg
obtundation, combativeness, or seizures (in approximately 50%) (1,2)

Reference:

(1) Wolfsdorf JI et al. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2014;15 Suppl 20:154-79.
(2) Pasquel FJ, Umpierrez GE. Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment. Diabetes Care. 2014;37(11):3124-31.

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