Hyperglycemic Hypernatremic Hypertonic State: A Predominant HHS Subtype and Its Clinical and Diagnostic Features

HHS with hypernatremia, defined by corrected sodium, is highly prevalent and clinically relevant, as corrected sodium better reflects the true free water deficit. HHS management should include evaluating both measured and corrected sodium, adopting effective serum osmolarity > 300 mOsm/L as a more sensitive diagnostic criterion, and reevaluating the exclusion criteria of significant ketonemia and acidosis. These refinements may enhance diagnostic accuracy and enable more personalized fluid management in HHS.