HHS

Question 1

What is HHS

Answer 1

Severe hyperglycemia in the absence of acidosis
Partial/relative insulin deficiency
• Reduced glucose utilization of muscle, fat, & liver
• Increased hyperglucagonemia
• Increased hepatic glucose output
• Massive glycosuria occurs
• Obligatory water loss ensues
• Associated acute or chronic illness
• Disallows adequate fluid intake
• Excessive fluid loss
• Plasma volume contracts
• Impaired renal function

Question 2

What has a higher mortality DKA or HHS?

Answer 2

HHS

Question 3

Causes of HHS

Answer 3

Infection
• Myocardial infarction
• Stroke
• Recent surgery/procedures
• Drug induced etc.

Question 4

S/S of HHS

Answer 4

Onset may be insidious
• Days to weeks
• Weakness, polyurea & polydipsia
• Lack of S&S or vague
• Until profound dehydration occurs
• Reduced fluid intake
• Lack of thirst
• Nausea
• Inaccessibility

Question 5

At what serum osmolality level does lethargy and confusion occur vs comatose and seizures in HHS

Answer 5

Lethargy/confusion: 310
Comatose/seizures: 330

Question 6

What is the glucose level in HHS

Answer 6

800-2400

Question 7

What happens to the BUN in HHS

Answer 7

Uremia >100

Question 8

What happens to the Na in HHS

Answer 8

Either normal or low d/t dilution

Question 9

What happens to the anion gap in HHS

Answer 9

Mildly elevated d/t lactic acidosis

Question 10

Do ketones develop in HHS

Answer 10

No

Question 11

What is the fluid resuscitation in HHS

Answer 11

NSS if hypovolemic
1/2 NSS if not hypovolemic
4-6 L of fluid over 8-10 hours for a goal of UO >50mls/ hr
When BG <250 switch to D5 1/2 NSS

Question 12

What is the insulin management for HHS

Answer 12

Delay insulin drip unless beta hydroxybuterate is >1
Regular insulin 0.05units/kg/hr- to lower glucose by 50-70 per hour
Can be switched to sub q once stable bg below 250

Question 13

How to manage potassium replacement in HHS

Answer 13

Less markedly present compared to DKA
Can add 20mEq to IVF