Can marked hyperglycemia occur without ketosis

The clinical spectrum of the hyperglycemic hyperosmolar syndrome (HHS) includes a heterogeneous group of patients who have in common a marked elevation in the blood glucose concentration, hyperosmolality and a range of disturbances in mentation. However, it is said that they lack an appreciable elevation in their circulating ketone body anion concentrations. As discussed previously, these patients must also have a low glomerular filtration rate in order to sustain high degrees of hyperglycemia. In the following sections, we shall present a quantitative analysis of the pathways of glucose formation and loss to demonstrate that cerebral ketone body oxidation is important for hyperglycemia in patients with hyperglycemic hyperosmolar syndrome especially if they are conscious and have not consumed glucose in the past 12-24 hours.