{ "schemaVersion": 2, "eyebrow": "Endocrinology", "title": "Hyperosmolar Hyperglycemic Syndrome", "summary": "Hyperosmolar hyperglycemic syndrome is a life-threatening hyperglycemic emergency requiring prompt recognition, volume resuscitation, electrolyte-directed insulin therapy, and evaluation for precipitating illness. The supplied search results do not contain HHS-specific diagnostic thresholds or treatment protocols; current emergency guidance should be consulted.", "seoDescription": "Point-of-care overview of hyperosmolar hyperglycemic syndrome, emphasizing immediate stabilization, monitoring priorities, and limits of the supplied evidence.", "clinicalQuestion": "How should physicians recognize and initially stabilize suspected hyperosmolar hyperglycemic syndrome?", "specialty": "Endocrinology and Emergency Medicine", "audience": "U.S. physicians and medical trainees", "tags": [ "hyperosmolar hyperglycemic syndrome", "HHS", "hyperglycemic crisis", "diabetes emergency" ], "keyTakeaways": [ "Treat suspected HHS as a medical emergency requiring immediate assessment of hemodynamics, mental status, glucose, electrolytes, renal function, and a precipitating illness; HHS-specific thresholds are not provided in the supplied sources.", "Do not extrapolate insulin, fluid, potassium, or osmolality targets from unrelated FDA labeling or other disease guidelines; no supplied source supports an HHS treatment regimen.", "Medication selection and dosing in renal or hepatic dysfunction require attention to altered drug clearance, but the supplied FDA guidance is general and does not provide HHS-specific recommendations. [4][5]" ], "sections": [ { "id": "clinical-priority", "eyebrow": "Immediate action", "heading": "Stabilize first and establish the hyperglycemic-crisis phenotype", "intro": "HHS-specific diagnostic and management guidance was not retrieved in the supplied results.", "paragraphs": [ "The supplied search set contains no HHS guideline, consensus report, emergency-care pathway, diagnostic criteria, fluid protocol, insulin protocol, potassium-replacement protocol, or outcome study. Therefore, it cannot support specific diagnostic thresholds for glucose, effective osmolality, ketonemia, pH, bicarbonate, corrected sodium, or mental-status criteria.", "In a patient with suspected hyperglycemic crisis, prioritize immediate clinical stabilization and obtain data needed to distinguish severe hyperglycemia with hyperosmolality from diabetic ketoacidosis, mixed ketoacidotic-hyperosmolar states, sepsis, stroke, toxic-metabolic encephalopathy, renal failure, and medication-related dysglycemia. Use institutionally approved or current specialty-society HHS protocols for definitive treatment details." ], "bullets": [ "Assess airway protection, circulatory status, perfusion, neurologic status, urine output, infection risk, and possible ischemic or neurologic precipitants.", "Obtain bedside glucose and urgent chemistry testing; add ketone assessment and acid-base evaluation when clinically indicated.", "Review medication exposure and comorbid renal, hepatic, or cardiac disease before selecting fluids, insulin, electrolyte replacement, or adjunctive therapies." ], "subsections": [], "table": { "caption": "Immediate assessment domains for suspected HHS; specific thresholds and treatment triggers are not available in the supplied evidence.", "columns": [ "Domain", "Immediate purpose", "Decision consequence" ], "rows": [ [ "Hemodynamics and volume status", "Identify shock, severe dehydration, or need for monitored resuscitation.", "Escalate level of care and initiate protocol-based resuscitation." ], [ "Neurologic examination", "Define altered consciousness and evaluate for focal deficits or seizure.", "Pursue concurrent evaluation for stroke, infection, toxic-metabolic causes, or other intracranial pathology when indicated." ], [ "Serum chemistry and renal function", "Characterize glucose, electrolytes, kidney function, and treatment-related electrolyte risk.", "Use a current HHS pathway for fluid, insulin, and electrolyte decisions; reduced renal function can alter drug handling. [4]" ], [ "Acid-base and ketone assessment", "Assess for ketoacidosis or mixed hyperglycemic crisis.", "Avoid assuming isolated HHS when acidosis or ketonemia is present." ], [ "Precipitant evaluation", "Identify infection, ischemia, medication effects, missed therapy, or another acute illness.", "Treat the precipitating condition concurrently with metabolic correction." ] ] } }, { "id": "treatment-evidence-limitations", "eyebrow": "Evidence boundary", "heading": "Do not infer a treatment protocol from the available sources", "intro": "The retrieved evidence is not HHS-specific.", "paragraphs": [ "FDA prescribing-information guidance describes how drug labels should communicate dose, frequency, titration, monitoring, administration, interaction-based modifications, and renal or hepatic adjustments when applicable. It does not provide clinical recommendations for HHS treatment. [1][2]", "FDA guidance emphasizes that impaired kidney function can alter pharmacokinetics of drugs cleared renally and, in some circumstances, drugs cleared predominantly by nonrenal pathways. It also notes that renal-replacement therapy may materially affect drug elimination. [4] This supports careful medication review in HHS, but it does not establish insulin dosing, fluid composition, electrolyte thresholds, or dialysis indications for HHS.", "Similarly, hepatic impairment can alter drug metabolism, excretion, protein binding, and pharmacodynamic response; the supplied FDA guidance recommends that dosing conclusions be based on drug-specific pharmacokinetic and exposure-response evidence. [5] It cannot be used to derive HHS-specific management adjustments." ], "bullets": [ "Use the current institutional HHS order set or an up-to-date diabetes-emergency guideline for exact fluid type and sequence, insulin route and dose, potassium and phosphate management, glucose targets, monitoring intervals, and transition therapy.", "Do not apply dose examples from unrelated products or conditions to HHS.", "When renal, hepatic, or cardiac dysfunction complicates resuscitation, use higher-acuity monitoring and disease-specific consultation as appropriate; the supplied sources do not specify an HHS protocol for these populations. [4][5]" ], "subsections": [], "table": { "caption": "What the supplied sources do and do not support for HHS management. [1][2][4][5]", "columns": [ "Clinical issue", "Supported by supplied sources", "Not supported by supplied sources" ], "rows": [ [ "Prescription-drug dosing information", "Drug labels should include recommended dose, interval, titration, monitoring, interaction modifications, and renal or hepatic adjustments when applicable. [1][2]", "Any HHS-specific insulin or electrolyte regimen." ], [ "Renal impairment", "Renal impairment can change drug pharmacokinetics, and dialysis can affect elimination of some drugs. [4]", "HHS fluid volume, potassium-replacement, insulin-dose, or dialysis thresholds." ], [ "Hepatic impairment", "Hepatic impairment can alter drug disposition and pharmacodynamic response. [5]", "HHS-specific insulin, fluid, or electrolyte modifications." ], [ "Acute hyperglycemic crisis", "Need for diagnosis-specific care cannot be established from these retrieved sources.", "Diagnostic criteria, monitoring frequency, disposition criteria, or mortality estimates for HHS." ] ] } }, { "id": "monitoring-and-disposition", "eyebrow": "Operational care", "heading": "Use serial reassessment to detect treatment complications and an alternate diagnosis", "intro": "Monitoring targets must come from a current HHS-specific protocol.", "paragraphs": [ "HHS care requires repeated reassessment because neurologic change, hemodynamic instability, evolving renal dysfunction, treatment-associated electrolyte shifts, and an unrecognized precipitating illness can alter management. The FDA labeling framework supports presenting clinically important monitoring and dose modifications clearly, but the provided sources do not specify HHS monitoring intervals or actionable thresholds. [1][2]", "If the clinical course is discordant with the presumed diagnosis—for example, persistent or worsening altered mental status, focal neurologic deficits, disproportionate acidosis, unexpected renal deterioration, or failure of metabolic improvement—broaden the differential and reassess for concurrent disease rather than escalating treatment solely on the assumption of uncomplicated HHS." ], "bullets": [ "Document serial mental status, vital signs, urine output, bedside glucose, and laboratory trends according to a current institutional or specialty-society HHS protocol.", "Reconcile outpatient diabetes therapies and interacting medications before discharge planning.", "Before transition out of acute care, establish a diabetes treatment plan, assess barriers to medication access and self-monitoring, and arrange close follow-up; exact discharge criteria are not supported by the supplied sources." ], "subsections": [], "table": { "caption": "Escalation prompts in suspected HHS; these are clinical reassessment triggers rather than evidence-based HHS thresholds from the supplied sources.", "columns": [ "Finding", "Concern", "Next action" ], "rows": [ [ "Persistent altered mental status or focal neurologic findings", "Alternative or concurrent neurologic process.", "Urgently reassess diagnosis and pursue neurologic evaluation as clinically indicated." ], [ "Hemodynamic deterioration or inadequate perfusion", "Inadequate resuscitation, sepsis, hemorrhage, cardiac dysfunction, or another cause of shock.", "Escalate monitoring and reassess resuscitation strategy and precipitating illness." ], [ "Unexpected electrolyte or renal deterioration", "Treatment complication, renal failure, or unrecognized comorbidity.", "Review medications and use protocol-based reassessment; renal impairment can alter drug disposition. [4]" ], [ "Failure of expected metabolic improvement", "Incorrect diagnosis, mixed hyperglycemic crisis, inadequate treatment delivery, or ongoing precipitant.", "Reassess diagnosis, treatment implementation, and concurrent illness." ] ] } } ], "faq": [ { "question": "What diagnostic thresholds define hyperosmolar hyperglycemic syndrome?", "answer": "The supplied search results do not contain HHS diagnostic criteria or threshold values. Use a current diabetes-emergency guideline or institutional HHS pathway rather than inferring thresholds from unrelated sources." }, { "question": "What fluid and insulin regimen should be used for HHS?", "answer": "No supplied source supports a specific HHS fluid, insulin, potassium, phosphate, or glucose-transition regimen. Use a current HHS-specific protocol; do not derive treatment doses from FDA labeling guidance for unrelated medications. [1][2]" }, { "question": "How should renal impairment change HHS treatment?", "answer": "The supplied FDA guidance supports that renal impairment can alter pharmacokinetics and that dialysis may affect drug elimination, but it does not provide HHS-specific fluid, insulin, or electrolyte adjustments. Use a current HHS protocol with individualized assessment of renal and cardiac status. [4]" }, { "question": "When should HHS prompt intensive care evaluation?", "answer": "The supplied evidence does not provide ICU criteria. Escalate care for airway risk, shock, severe neurologic dysfunction, major electrolyte abnormalities, significant renal or cardiac comorbidity, or a suspected severe precipitating illness." } ], "references": [ { "number": 1, "title": "How Do I Use Prescription Drug Labeling | FDA", "detail": "www.fda.gov", "url": "https://www.fda.gov/about-fda/oncology-center-excellence/how-do-i-use-prescription-drug-labeling", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 2, "title": "Dosage and Administration Section of Labeling for Human ...", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/72142/download", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 3, "title": "highlights of prescribing information - accessdata.fda.gov", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/212888s002lbl.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov" }, { "number": 4, "title": "Pharmacokinetics in Patients with Impaired Renal Function", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/78573/download", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 5, "title": "Pharmacokinetics in Patients with Impaired Hepatic Function", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/71311/download", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 6, "title": "JUXTAPID® (lomitapide) capsules, for oral use", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/203858s027lbl.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov" }, { "number": 7, "title": "- IIER - 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PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pubmed/41577383", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 18, "title": "[PDF] Review of Clinical Guideline (CG61) – Irritable bowel syndrome in ...", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/guidance/cg61/evidence/review-decision-2011-pdf-546302845", "authors": "www.nice.org.uk", "host": "www.nice.org.uk" }, { "number": 19, "title": "CDC Clinical Practice Guideline for Prescribing Opioids ...", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm", "authors": "www.cdc.gov", "host": "www.cdc.gov" }, { "number": 20, "title": "The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "http://www.ncbi.nlm.nih.gov/pubmed/18334580", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 21, "title": "Guidelines and Clinical Policy", "detail": "www.acc.org", "url": "https://www.acc.org/guidelines", "authors": "www.acc.org", "host": "www.acc.org" }, { "number": 22, "title": "AUA Guideline for the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome - PMC", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9341322", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 23, "title": "IDSA Guidelines on the Treatment and Management of ...", "detail": "www.idsociety.org", "url": "https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management", "authors": "www.idsociety.org", "host": "www.idsociety.org" }, { "number": 24, "title": "Canadian Society of Nephrology Commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis: management of nephrotic syndrome in children - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pubmed/24423782", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "How Do I Use Prescription Drug Labeling | FDA", "detail": "www.fda.gov", "url": "https://www.fda.gov/about-fda/oncology-center-excellence/how-do-i-use-prescription-drug-labeling", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "Dosage and Administration\n\nProvides the recommended dose, including the dosage range, dosing interval, usual duration, dosage modifications due to adverse reactions, recommended dosage in patients with renal or hepatic impairment if different from the dose from those with normal organ function, reco", "score": 0.4233394 }, { "number": 2, "title": "Dosage and Administration Section of Labeling for Human ...", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/72142/download", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "the same term which is generally used in an interchangeable biosimilarity 666 statement in the Highlights of Prescribing Information of interchangeable biosimilar 667 products.92,93 For example, this section should not state that “drugoxide liposome injection and 668 drugoxide injection are not inte", "score": 0.3649365 }, { "number": 3, "title": "highlights of prescribing information - accessdata.fda.gov", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/212888s002lbl.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov", "snippet": "drug therapy [see Clinical Pharmacology (12.3)]. 8.6 Renal Impairment Based on studies with oral cabotegravir and population pharmacokinetic analyses of oral rilpivirine, no dosage adjustment of CABENUVA is necessary for patients with mild (creatinine clearance 60 to <90 mL/min) or moderate renal i", "score": 0.3413854 }, { "number": 4, "title": "Pharmacokinetics in Patients with Impaired Renal Function", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/78573/download", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "blood, dialysis, and ultrafiltration flow rates. Dose and/or dosing interval adjustments can be recommended to correct for clinically relevant changes in drug exposure. There may be different recommended dosages for different filter types and CRRT modalities. The sponsor should provide data/justific", "score": 0.33189937 }, { "number": 5, "title": "Pharmacokinetics in Patients with Impaired Hepatic Function", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/71311/download", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "function on __________ pharmacokinetics or pharmacodynamics (if known) is sufficiently small that no dosing adjustment is required. Contains Nonbinding Recommendations 12 For cases in which impaired hepatic function requires dosing adjustments, the appropriate information should be included. Special", "score": 0.31000513 }, { "number": 6, "title": "JUXTAPID® (lomitapide) capsules, for oral use", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/203858s027lbl.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov", "snippet": "aged 9 years and older, or 200 IU for patients aged 2 to 8 years old] and linoleic acid (200 mg), alpha-linolenic acid (210 mg), eicosapentaenoic acid (110 mg), and docosahexaenoic acid (80 mg) supplements (2.2). • Take orally once daily, whole, with water and without food, at least 2 hours after ev", "score": 0.24454379 }, { "number": 7, "title": "- IIER - accessdata.fda.gov", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/219962Orig1s000Lbl.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov", "snippet": "\"ll U1\"11~0.!I 0110lh I OilO::Oq ~~Cl) ·~ o,opoj P'J::8JIP lllll.11'4' ' '\"µn tlllH~a.d LIi Sf!JOIII\"\"' o, ~ wnpo, w:,:0.!le, Oil qpuµ~~dw1~1'P){4) READ AND K", "score": 0.21885334 }, { "number": 8, "title": "Corticobasal syndrome: a practical guide", "detail": "pn.bmj.com", "url": "https://pn.bmj.com/content/21/4/276", "authors": "pn.bmj.com", "host": "pn.bmj.com", "snippet": "syndrome by the careful neurological examination to identify peripheral (such as areflexia, proprioceptive loss) or central (eg, pyramidal) nervous system signs, combined with appropriate investigations such as MR scan of brain, electroencephalogram, serum antineuronal and other autoantibody assays,", "score": 0.47343868 }, { "number": 9, "title": "Stiff-person syndrome | Practical Neurology", "detail": "pn.bmj.com", "url": "https://pn.bmj.com/content/25/1/6", "authors": "pn.bmj.com", "host": "pn.bmj.com", "snippet": "MRI can rarely show hyperintensities in the spinal cord and brainstem.15 Treatment with a combination of corticosteroids, IVIG, plasma exchange or rituximab is beneficial.48 Although PERM has a severe presentation with a mortality as high as 40%,49 it often shows a robust response to treatment.15 Th", "score": 0.182907 }, { "number": 10, "title": "KDOQI US Commentary on the KDIGO 2025 Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0272638625011473", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: KDOQI US Commentary on the KDIGO 2025 Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children - ScienceDirect\n## American Journal of Kidney Diseases. Volume 87, Issue 2, February 2026, Pages 141-152. American Journal of Kidney Diseases. # KDOQI Commentary KDOQI US Com", "score": 0.54681134 }, { "number": 11, "title": "Medicine's Service Challenge : Health Care Management ...", "detail": "journals.lww.com", "url": "https://journals.lww.com/hcmrjournal/fulltext/2005/10000/medicine_s_service_challenge__blending_custom_and.6.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "by RMJ Bohmer · 2005 · Cited by 101 — Using examples drawn from health care delivery, this paper introduces three operational strategies for effectively combining custom and standard clinical", "score": 0.023261933 }, { "number": 12, "title": "Minor change in the diagnostic threshold leads into major ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0165032709002857", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "by L Karlsson · 2010 · Cited by 28 — The diagnostic thresholds associated with impairment, episode duration, treatment need and use. falling below the diagnostic threshold may have clinically", "score": 0.2557877 }, { "number": 13, "title": "Diagnosis and Prognosis in Disorders of Consciousness ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1155/2023/3991087", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "This study seeks to determine the proportion of patients, with unresponsive wakefulness syndrome and minimally conscious state, who display", "score": 0.23322617 }, { "number": 14, "title": "The threshold model revisited", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdf/10.1111/jep.13091", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "by B Djulbegovic · 2019 · Cited by 40 — Pt = RVH·Hrx RRR·M . (3) This equation gives the threshold for the probability of diagnosis of disease at which the rational patient with preferences expressed", "score": 0.19808003 }, { "number": 15, "title": "Thresholds for clinical importance were defined for the ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0895435619306213", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "by JM Giesinger · 2020 · Cited by 23 — The thresholds from our study have excellent diagnostic accuracy for the identification of clinically important symptoms and functional health impairments", "score": 0.18440038 }, { "number": 16, "title": "A simulation study into the performance of “optimal ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S089543561300348X", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "by G Hirschfeld · 2014 · Cited by 22 — At the population level, the thresholds defined for the four ESs (0.5, 0.8, 2, and 4) yielded a median of 59%, 65%, 83%, and 97% correct classifications,", "score": 0.1515673 }, { "number": 17, "title": "KDOQI US Commentary on the KDIGO 2025 Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pubmed/41577383", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "The Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the 2025 KDIGO (Kidney Disease: Improving Global Outcomes) Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children. The KDOQI work group reviewed the KDIGO guideline statements and practic", "score": 0.62742686 }, { "number": 18, "title": "[PDF] Review of Clinical Guideline (CG61) – Irritable bowel syndrome in ...", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/guidance/cg61/evidence/review-decision-2011-pdf-546302845", "authors": "www.nice.org.uk", "host": "www.nice.org.uk", "snippet": "during the 2 week consultation period. Review proposal put to consultees: The guideline should not be updated at this time. The guideline will be reviewed again according to current processes. CG61: Irritable bowel syndrome in adults Review Decision 4 of 18 12. The majority of stakeholders agreed wi", "score": 0.49040702 }, { "number": 19, "title": "CDC Clinical Practice Guideline for Prescribing Opioids ...", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm", "authors": "www.cdc.gov", "host": "www.cdc.gov", "snippet": "Review of the patient’s history and context beyond the presenting pain syndrome is helpful in selection of pain treatments. In particular, medications should be used only after assessment and determination that expected benefits outweigh risks, considering patient-specific factors. For example, clin", "score": 0.33089322 }, { "number": 20, "title": "The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "http://www.ncbi.nlm.nih.gov/pubmed/18334580", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Consensus process:\nConsensus was guided by systematic reviews of evidence and discussions. The guidelines were reviewed and approved sequentially by The Endocrine Society's CGS and Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council. At each stage ", "score": 0.32110915 }, { "number": 21, "title": "Guidelines and Clinical Policy", "detail": "www.acc.org", "url": "https://www.acc.org/guidelines", "authors": "www.acc.org", "host": "www.acc.org", "snippet": "# \n\n# Guidelines & Clinical Policy\n\nTransforming CV Care For All\n\n## Newest Guideline\n\nCardiovascular-Kidney-Metabolic Syndrome\n\n## Mobile Guideline Clinical App\n\nGuidelines always within reach.\n\nFor more than 75 years, the ACC has been a trusted source of evidence-based cardiovascular guidance, del", "score": 0.2837149 }, { "number": 22, "title": "AUA Guideline for the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome - PMC", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9341322", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "A systematic review of the literature using the MEDLINE® database (search dates 1/1/83–7/22/09) was conducted to identify peer reviewed publications relevant to the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Insufficient evidence-based data were retrieved regarding diagn", "score": 0.28231043 }, { "number": 23, "title": "IDSA Guidelines on the Treatment and Management of ...", "detail": "www.idsociety.org", "url": "https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management", "authors": "www.idsociety.org", "host": "www.idsociety.org", "snippet": "341. Stierman B, Abrams JY, Godfred-Cato SE, et al. Racial and Ethnic Disparities in Multisystem Inflammatory Syndrome in Children in the United States, March 2020 to February 2021. Pediatr Infect Dis J 2021; 40(11): e400-e6.\n\n342. Belay ED, Abrams J, Oster ME, et al. Trends in Geographic an", "score": 0.25384757 }, { "number": 24, "title": "Canadian Society of Nephrology Commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis: management of nephrotic syndrome in children - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pubmed/24423782", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Title: Canadian Society of Nephrology Commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis: management of nephrotic syndrome in children - PubMed\nAn official website of the United States government. **The .gov means it’s official.**. Federal government websites often end i", "score": 0.25272554 } ], "publishedAt": "2026-08-20T23:34:47.170319Z", "updatedAt": "2026-08-20T23:34:47.170319Z", "readingMinutes": 3, "slug": "hyperosmolar-hyperglycemic-syndrome" }