{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T03:02:36Z","timestamp":1779850956806,"version":"3.53.1"},"reference-count":48,"publisher":"American Dental Society of Anesthesiology (ADSA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>The hyperosmolar hyperglycemic state (HHS) is an acute metabolic complication of diabetes mellitus type 2 (DMT2) and a life-threatening emergency. A 76-year-old man with DMT2 that was well controlled with oral medications underwent oral cancer surgery. Postoperatively, a surgical site infection and aspiration pneumonia developed, exacerbating the patient\u2019s diabetes. His blood glucose level increased to &gt;500 mg\/dL, and both dehydration and hyperosmolality were observed. His effective plasma osmolality exceeded 300 mOsm\/kg and corrected serum sodium level was 159 mEq\/L, which were suggestive of HHS. Because the leading cause of HHS is surgical site infection, emergency surgery was scheduled for infection control. Prior to general anesthesia, the patient received an infusion of 500 mL of normal saline and insulin. Awake intubation was performed after the administration of midazolam and fentanyl after which general anesthesia was induced. The patient tolerated the emergent procedure well, and his HHS resolved. As HHS can occur even in patients with adequately controlled DMT2, the signs and symptoms of HHS must be monitored carefully during the perioperative period.<\/jats:p>","DOI":"10.2344\/24-0054","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T15:26:23Z","timestamp":1772810783000},"page":"33-38","source":"Crossref","is-referenced-by-count":0,"title":["Anesthetic Management of a Diabetic Patient With a Suspected Hyperosmolar Hyperglycemic State: A Case Report"],"prefix":"10.2344","volume":"73","author":[{"given":"Akiyo","family":"Kawano","sequence":"first","affiliation":[{"name":"Department of Oral Health Sciences, Otemae College, Nishinomiya, Hyogo, Japan"},{"name":"Department of Dental Anesthesiology, Graduate School of Dentistry, The University of Osaka, Suita, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuka","family":"Honjo","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Graduate School of Dentistry, The University of Osaka, Suita, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Graduate School of Dentistry, The University of Osaka, Suita, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayoshi","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Graduate School of Dentistry, The University of Osaka, Suita, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiho","family":"Kudo","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Graduate School of Dentistry, The University of Osaka, Suita, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Niwa","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Graduate School of Dentistry, The University of Osaka, Suita, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1191","reference":[{"issue":"5","key":"i1878-7177-73-1-33-b01","series-title":"Curr Diab Rep","first-page":"33","article-title":"Treatment of diabetic ketoacidosis (DKA)\/hyperglycemic hyperosmolar state (HHS): novel advances in the management of hyperglycemic crises (UK versus USA)","volume":"17","author":"Dhatariya KK","year":"2017","unstructured":"Dhatariya KK,\nVellanki P. 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Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg. 1999;67(2):352\u2013360; discussion 360\u2013362."},{"issue":"2","key":"i1878-7177-73-1-33-b14","series-title":"J Parenter Enteral Nutr","first-page":"77","article-title":"Early postoperative glucose control predicts nosocomial infection rate in diabetic patients","volume":"22","author":"Pomposelli JJ","year":"1998","unstructured":"Pomposelli JJ,\nBaxter JK 3rd,\nBabineau TJ, et al. Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. J Parenter Enteral Nutr. 1998;22(2):77\u201381."},{"issue":"4","key":"i1878-7177-73-1-33-b15","series-title":"Diabet Med","first-page":"420","article-title":"Joint British Diabetes Societies. 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