38: HHS - Thompson

Question 1

What are the signs and symptoms of HHS?

Answer 1

dehydration
No Kussmaul breathing
Mental status change
Abdominal Pain

Question 2

What is the mortality and compare to DKA?

Answer 2

Higher is HHS - usually older and more comorbidites

Question 3

What is the difference in pH in HHS v DKA?

Answer 3

HHS normal

DKA LOW

Question 4

Who is at risk for HHS?

Answer 4

uncontrolled type 2

increased age and with comorbidities

stress can trigger

Question 5

What is criteria for diagnosis HHS?

Answer 5

Glu 600
Osmo 320 (high Na)
Dehydrations
Ph 7.3 (not too low)
Bicarb 15
Ketonuria with no or small ketonemia
Mental Status Change

Question 6

A1c criteria for DM and IGT?

Answer 6

DM greater than 6.5%

IGT 5.7 - 6.4%

Question 7

What is treatment of HHS?

Answer 7

• IVF (1L/r to drop glu 75-100/hr) (avg fluid deficit is 9 L)
• maybe insulin
• potassium (monitor electrolytes)
• be concerned about brain swelling (lower sodium too quickly)
• Abx/tylenol/anti-nausea if needed

Question 8

What electrolytes need monitoring with HHS?

Answer 8

K and Na (usually high)

Question 9

What meds and medical situations can increase glucose (beyond diabetes)?

Answer 9

contraceptive
hydrocholorothiazide
steroids
pregnancy (hormone changes) 
MI
stroke
dehydration

Question 10

What likely brought on HHS in this patient?

Answer 10

pregnancy

Question 11

Send patient with HHS home or admit?

Answer 11

admit for monitoring

Question 12

DKA or HHS?

Answer 12

• DKA comes on more quickly
• HHS mental status change! No acidosis.
• HHS is Type 2
• HHS 3 weeks
• No kusshmaul breathing HHS

Question 13

HHS like or unlike DKA?

Answer 13

• comes on slower
• higher mortality
• mental status change common in both
• 35% when diabetes found
• Type 2
• Not as much acid/base imbalance
• Potassium issue more from fluid replacement or vomiting
• Like DKA, often precipitating stress