Hyperosmolar Hyperglycemic State (HHS) By Erika F Brutsaert, MD, New York Medical College Reviewed / Revised Sep 2022 View Patient Education Symptoms and Signs Diagnosis Treatment Key Points Topic Resources Anion Gap Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness.