• Jennifer Hackel.
• College of Nursing and Health Science, University of Massachusetts, Boston, Massachusetts.
• J Am Assoc Nurse Pract. 2014 Nov 1; 26 (11): 595-602.

PurposeThe purpose of this case study is twofold: first, to present the pathophysiology of hyperosmolar hyperglycemic state (HHS) as it relates to a hospitalized patient with undiagnosed diabetes; the second is to increase awareness among primary care nurse practitioners (NPs) about the complexities of diagnosing less typical forms of diabetes. The case illustrates how HHS can be life threatening, how it is differentiated from diabetic ketoacidosis (DKA), and how it is treated. The importance of closer surveillance of blood glucose in high-risk individuals is highlighted.Data SourcesReview of the literature and application to the case.ConclusionsHHS is a potentially lethal and preventable hyperglycemic crisis, which is in a continuum with DKA, occurring frequently in individuals with no prior diagnosis of diabetes. The incidence of HHS is increasing as the epidemic of diabetes continues. It is important for NPs to understand the pathophysiology of HHS, and identify which patients are at risk. Many high-risk patients, when under stress, develop acute hyperglycemic crisis, which begets further cardiovascular complications.Implications For PracticeWith improved understanding of the phenomena leading to glucose dysregulation, less typical forms of diabetes might be identified earlier and controlled. NPs in primary care are uniquely positioned to reduce the risk of hyperglycemic crises.©2014 American Association of Nurse Practitioners.

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