Hyperosmolar hyperglycemic state in elderly and senile patients

Hyperglycemic hyperosmolar state (HHS) is an acute and life-threatening hyperglycemic emergency that often occurs in elderly and senile patients and leads to significant morbidity and mortality. The aim of this review is to provide up-to-date knowledge about the epidemiology, pathophysiology, clinical picture and recommendations for the diagnosis, treatment and prevention of HHS in elderly and senile patients. Material and methods. To achieve this goal, a search and analysis of full-text articles was conducted using the PubMed, Web of Science and Scopus databases. The search was conducted using the key terms “hyperglycemic hyperosmolar state” and “elderly and senile patients”. It included randomized controlled trials, meta-analyses and individual book editions and covered English- and Ukrainian-language publications over the past 25 years (from May 2000 to April 2025). As a result of the conducted studies, it was found that against the background of acute severe hyperglycemia with osmotically stimulated diuresis in patients of the older age group, a condition arises, which is characterized by: severe dehydration; high hyperglycemia (above 30 mmol/l); hyperosmolarity (over 320 mOsm/l); absence of acidosis; significant disturbances of consciousness and vital functions. The prognosis and outcome of treatment of patients with HHS are determined by the severity of dehydration, the presence of concomitant diseases and age >65 years. The article describes the features of pathogenesis, risk factors, diagnostic criteria, clinical manifestations and treatment of patients with HHS. Conclusions. HHS remains a formidable complication of diabetes mellitus in elderly patients, which requires increased attention of specialists of various profiles. Severe HHS is characterized by profound dehydration, water-electrolyte imbalance, neurological disorders and impaired consciousness. HHS therapy should be carried out taking into account the individual characteristics of the elderly and senile patient in order to prevent the development of side effects and complications. Keywords: diabetes mellitus, hyperosmolar hyperglycemic state, elderly and senile patients, intensive care