Symposium: diabetes mellitusHyperglycaemic Hyperosmolar State (HHS) in children: a practical guide to management

Hyperglycaemic Hyperosmolar State (HHS), also known previously as Hyperosmolar Hyperglycaemic Non-Ketotic Coma (HONK) is a life-threatening but preventable acute metabolic complication of diabetes. It is becoming more common in childhood and optimal outcomes require a good understanding of the condition. It is very important that HHS is distinguished from DKA, as the management differs significantly, and HHS has a high morbidity and it can prove fatal. This review discusses the pathophysiology, how to make the diagnosis and the recommended treatment of this condition in children. The best clinical management of HHS in childhood involves careful correction of fluids and biochemical status of the patient and identification of precipitating causes whilst carefully monitoring for complications.