HYPERGLYCEMIC HYPEROSMOLAR STATE is a topic covered in the Harrison's Manual of Medicine.

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Relative insulin deficiency and inadequate fluid intake are the underlying causes of HHS. Hyperglycemia induces an osmotic diuresis that leads to profound intravascular volume depletion. HHS is often precipitated by a serious, concurrent illness such as myocardial infarction or sepsis and compounded by conditions that impede access to water.

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