HHS Flashcards
what is HHS?
Hyperosmolar hyperglycaemic state (HHS)
results in osmotic diuresis, severe dehydration, and electrolyte deficiencies. HHS typically presents in the elderly with type 2 diabetes mellitus (T2DM).
what is the pathophysiology?
hyperglycaemia → ↑ serum osmolality → osmotic diuresis → severe volume depletion
what are precipitating factors?
intercurrent illness
dementia
sedative drugs
what are the features?
HHS comes on over many days, and consequently, the dehydration and metabolic disturbances may be more extreme
clinical signs of dehydration
polyuria
polydipsia
lethargy
N+V
altered level of consciousness
focal neurological deficits
hyperviscosity (may result in myocardial infarctions, stroke and peripheral arterial thrombosis)
what is usually required to diagnose?
NOT DIAGNOSTIC CRITERIA
what is the mx?
IV 0.9% sodium chloride solution
typically given at 0.5 - 1 L/hour depending on clinical assessment
potassium levels should be monitored and added to fluids depending on the level
Insulin SHOULD NOT be given unless blood glucose stops falling while giving IV fluids
patients are at risk of thrombosis due to hyperviscosity so give VTE prophylaxis
what are the complications?
vascular complications may occur due to hyperviscosity:
such as myocardial infarction
stroke