Table 2

Diagnostic criteria of HHS first reported by Arieff and Carroll and current ADA criteria

Arieff and Carroll (56)ADA (4)
Plasma glucose, mg/dL>600>600
Arterial pHN/A>7.30
Serum bicarbonate, mEq/LN/A>18
Urine or serum ketones by nitroprussiate test (acetoacetate)0 to 2 plusesNegative or small
Serum β-hydroxybutyrate, mmol/LN/A<3 mmol/L
Total serum osmolality, mOsm/kg*>350N/A
Effective serum osmolality, mOsm/L**N/A>320
Anion gap, mEq/LN/AVariable
Mental statusN/AVariable; most patients present with stupor, coma
  • *Total serum osmolality formula = 2(Na) + 18/glucose + BUN/2.

  • **Effective serum osmolality formula = 2(Na) + 18/glucose.