HHS

Question 1

What is the plasma glucose level criterion for Hyperosmolar Hyperglycemic State (HHS)?

Answer 1

> 600 mg/dL (>33.3 mmol/L)

This criterion indicates severe hyperglycemia in HHS.

Question 2

What is the effective serum osmolality criterion for HHS?

Answer 2

> 320 mOsm/kg (>320 mmol/kg)

Elevated osmolality is a key feature of HHS.

Question 3

What arterial pH level is indicative of HHS?

Answer 3

> 7.30

A pH above this level suggests minimal acidosis in HHS.

Question 4

What is the serum bicarbonate level criterion for HHS?

Answer 4

> 18 mEq/L (>18 mmol/L)

This level indicates that ketoacidosis is minimal or absent.

Question 5

What is a common characteristic of dehydration in HHS?

Answer 5

Severe dehydration

Dehydration is a significant complication in HHS.

Question 6

Name a common precipitating factor for HHS.

Answer 6

Infection (e.g., pneumonia, urinary tract infection)

Infections can lead to stress hyperglycemia, contributing to HHS.

Question 7

What is another common precipitating factor for HHS?

Answer 7

Discontinuation or inadequate insulin therapy

Insufficient insulin can precipitate HHS due to uncontrolled hyperglycemia.

Question 8

What is a common issue affecting older patients that can lead to HHS?

Answer 8

Compromised water intake

Older patients may not consume enough fluids, increasing the risk of HHS.

Question 9

List two acute major illnesses that can precipitate HHS.

Answer 9

• Myocardial infarction
• Cerebrovascular accident

These conditions can lead to stress and hyperglycemia.

Question 10

What is the initial fluid treatment for HHS?

Answer 10

Isotonic 0.9% NaCl at 15-20 mL/kg over the first hour

This helps to rehydrate the patient effectively.

Question 11

How should fluid type be adjusted after the initial treatment for HHS?

Answer 11

Based on volume status and corrected serum sodium

Adjustments ensure optimal fluid management.

Question 12

What fluid should be avoided in HHS treatment and why?

Answer 12

Hypertonic saline (3.0%)

It may worsen hypernatremia and hyperosmolarity.

Question 13

What is the intravenous bolus dosage of regular insulin for HHS treatment?

Answer 13

0.1 units/kg body weight

This is followed by a continuous infusion for effective management.

Question 14

How should the continuous infusion of insulin be calculated?

Answer 14

0.1 units/kg per hour

An alternative higher dose of 0.14 units/kg/hour can be used without a bolus.

Question 15

For a 100 kg patient, what is the bolus and drip dosage of insulin?

Answer 15

Bolus: 10 units; Drip: 10 units/hour

This ensures adequate insulin delivery in HHS.

Question 16

What is the best approach for administering fluids and insulin in a patient with HHS?

Answer 16

1.5 L of 0.9% NaCl over the first hour, followed by a bolus of 10 units insulin and a continuous infusion of 10 units/hour

This approach addresses both dehydration and hyperglycemia effectively.