DM: Hyperosmolar Hyperglycaemia State Flashcards
Outline the pathophysiology of HHS
Reduction in insulin with a rise in counterregulatory hormones (adrenaline, glucagon, growth hormone, cortisol)
Insulin remains high enough to inhibit lipolysis and ketogenesis (no DKA) but insufficient to prevent hyperglycaemia
Osmotic diuresis = decrease in water, loss of electrolytes. [Glucose] increases due to loss of circulating vol. In an insulinopenic state, hyperglycaemia is exacerbated by continued gluconeogenesis and inability to clear glucose.
Characterized by hyperglycaemia, hyperosmolality, and dehydration without significant ketoacidosis
Outline the aetiology of HHS
Acute illness that increases counterregulatory hormones =
Stroke
Intracranial haemorrhage
MI
PE
Acute pancreatitis
Drugs that raise glucose, inhib insulin or cause dehydration =
- Alcohol, cocaine, propranolol, phenytoin, Ca channel blockers, beta blockers, corticosteroids, diuretics, immunosuppressants, statins
Noncompliance with oral hypoglycaemics or insulin therapy
What are signs and symptoms of HHS?
Tachycardia
Tachypnoea
Orthostatic hypotension
Hypotension
Neurological = lethargy, delirium, coma, focal/generalised seizures, visual changes, hemiparesis, sensory deficits
Reduced cap refill
How would you investigate HHS?
Baseline obs = HR, RR, BP, sats
ECG
Bloods = FBC, glucose, osmolality, HbA1c, U+Es, ketones
ABG
Urine analysis
Imaging = CXR, AXR, CT head
How would you manage HHS?
A-E assessment = airway management, fluids
IV insulin
Sepsis = sepsis 6
Treat underlying disease
What are the complications of HHS?
Electrolyte abnormalities
Cerebral oedema
Acute respiratory distress syndrome (ARDS)
Mortality 5-10%
What are the diagnosis criteria for HHS?
Hypovolaemia
Hyperglycaemia = >30mmol/L without significant hyperketonaemia (<3mol/L) or acidosis (>7.3, bicarb >15mmol/L)
Osmolality >320 mosmol/kg
