EndocrinologyEmergency Medicine
Hyperosmolar Hyperglycaemic State (HHS)
Hyperosmolar Hyperglycaemic State (HHS) clinical pathway.
Source: NICE; JBDS; RCP — NG18
Step 1 of ~3
info
Diagnosis
HHS Criteria:
• Severe hyperglycaemia (>30 mmol/L)
• Hyperosmolality (>320 mOsm/kg)
• NO significant ketonaemia (<3 mmol/L)
• pH >7.3
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- Methylene Blue · Guanylate Cyclase / Nitric Oxide Pathway Inhibitor
- Sodium phenylbutyrate · Ammonia scavenger (alternative pathway)
- Marstacimab · Anti-tissue factor pathway inhibitor (TFPI) monoclonal antibody
- Glasdegib (Specialist drug) · Hedgehog pathway inhibitor
- Vismodegib (Specialist drug) · Hedgehog pathway (SMO) inhibitor
Pathways
- Diabetic Ketoacidosis (DKA) · JBDS 2013 / Joint British Diabetes Societies; NICE NG17
- Adult Hypoglycaemia (Treated Diabetes) · JBDS-IP (2023): Hospital Management of Hypoglycaemia
- Adrenal Crisis · Society for Endocrinology Emergency Guidance (2024)
- Type 2 Diabetes Management · NICE NG28 2022
- Hyperthyroidism Management · BTA / ETA 2018
- Adrenal Insufficiency · Society of Endocrinology / ESE 2016
Decision support only. Always apply local guidelines and clinical judgement.