Endocrine disorders: Hyperglycemic Hyperosmolar Syndrome

Question 1

How is it possible to diagnose Hyperglycemic hyperosmolar syndrome in small animal patients?

Answer 1

Serum glucose of greater than 600 mg/dl in the absence of ketones, and a serum osmolarity greater than 350mOsm/kg

Other findings include dehydration, azotemia, increased P, AST and lactate, and decreased Cl

Question 2

How can DKA and hyperglycemic hyperosmolar syndrome be differentiated?

Answer 2

The presence of ketones will be seen in DKA, and not HHS

Question 3

The first goal of therapy for patients with HHS is? What are other therapies that may be indicated as well?

Answer 3

Fluid therapy (isotonic saline) to replace vascular volume with signs of or in hypovolemic shock (20 ml/kg in cats, 30 ml/kg in dogs) or hypotonic saline if hypernatremia is noted, insulin (similar to DKA treatment protocols)

Question 4

What electrolyte(s) should be monitored closely during treatment of patients with HHS?

Answer 4

Potassium, phosphorous, magnesium, and sodium