Wednesday, September 29, 2021

History of hyperosmolar hyperglycemic state

Hyperosmolar hyperglycemic syndrome (HHS) is a clinical condition that arises from a complication of diabetes mellitus. Type 2 diabetes accounts for about 90% to 95% of diabetes cases. It is most commonly seen in patients with obesity.

In 1828, in the textbook Versuch einer Pathologie und Therapie des Diabetes Mellitus, August W. von Stosch gave the first detailed clinical description of diabetic coma in an adult patient with severe polydipsia, polyuria, and a large amount of glucose in the urine followed by progressive decline in mental status and death.

Hyperosmolar hyperglycemic state is thought to have been first described by von Frerichs and Dreschfeld in the 1880s in patients with an “unusual diabetic coma” characterized by severe hyperglycemia and glycosuria in the absence of Kussmaul breathing, with a fruity breath odor or positive acetone test in the urine. This clinical condition was formerly called non-ketotic hyperglycemic coma; hyperosmolar hyperglycemic non ketotic syndrome, and hyperosmolar non-ketotic coma.

In the Bradshawe lecture delivered by Dreschfield in 1886, he described three types of diabetic coma. The first one that he described is a gradual coma in older adults (age >40) and in overweight adults without the characteristic acetone breath or acetone in the urine. After this case, several authors described diabetic coma in which polydipsia and polyuria were accompanied by hyperglycemia but without the characteristic Kussmaul breathing seen in DKA (Diabetic Ketoacidosis).

In the early 1900s, others reported the presence of two distinct types of patients with diabetic coma, noting that not all cases presented with the characteristic Kussmaul respiration or positive urine acetone or diacetic acid. These reports created confusion and were taken with skepticism, as the source of ketone bodies and the role of acetoacetic acid in the pathogenesis of diabetic coma were not known at the time.

The initial definition and diagnostic criteria of HHS wea derived from a few cases reported by Gerich and Arieff and Carroll in 1971. Arieff and Carroll in 1971 proposed a diagnostic criterion for this entity they named ‘hyperglycemic hyperosmolar nonketotic coma’ Later, the terminology was revised to ‘hyperglycemic hyperosmolar state.
History of hyperosmolar hyperglycemic state

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