TABLE 3

Changes in hyperglycemic hyperosmotic state diagnostic criteria between 2009 consensus statement and 2024 consensus report

Diagnostic criteria2009 Consensus statement42024 Consensus report5
HyperglycemiaPlasma glucose > 600 mg/dLPlasma glucose ≥ 600 mg/dL
HyperosmolalityCalculated effective serum osmolality
> 320 mOsm/kg		Calculated osmolality:
Effectivea > 300 mOsm/kg
OR
Totalb > 320 mOsm/kg
Absence of significant ketosisSerum ketones: Small
Urine ketones: Small		Beta-hydroxybutyrate < 3 mmol/L
OR
Urine ketones < 2+
Absence of significant acidosispH > 7.3
Bicarbonate > 18 mmol/L		pH ≥ 7.3
AND
Bicarbonate ≥ 15 mmol/L
Mental statusStupor or comaRemoved as a diagnostic criterion

  • ↵aEffective osmolality calculated as 2[sodium (mmol/L)] + glucose (mmol/L)

  • ↵bTotal osmolality calculated as 2[sodium (mmol/L)] + glucose (mmol/L) + urea (mmol/L)