HHS Flashcards
HHS
complication of T2DM in which high blood sugar results in high osmolarity without significant ketoacidosis
onset
longer than DKA (>1 week)
what is the main risk factor
T2DM
who is it usually seen in
older indivduals
younger non-Caucasians
precipitating factors
Usually precipitated by an infection, MI, stroke or other acute illness
Some medications are risk factors e.g. glucocorticoids and thiazides.
how can steroids and thiazides induce HHS
induce hyperglycaemia
clinical features
Hyperosmolar state leads to excessive urination, which in turn leads to dehydration and drowsiness, confusion and coma
weakness
leg cramps
trouble seeing
definition
hypovolaemia
hyperglycaemia (BG>30 mmol/L) without significant acidosis/ketonaemia
hyperosmolar (osmolality >320 mosmol/kg)
NB a mixed picture is common
typical biochemistry:
glucose, renal, sodium, osmolality, ketones
higher glucose than in DKA (60mmol/L)
significant renal impairment
sodium raised on admission
significant elevation of osmolality = significant dehydration
less ketonaemic/acidotic
how does one calculate plasma osmolality
normal level of plasma osmolality
285-295
impaired consciousness is seen at what plasma osmolality level
around 340
outline the differences in treatment between DKA and HHS
in HHS:
- fluids must be normalised gradually and safely
- insulin given more slowly as the patient will be more sensitive to it, it may not even be required
- rapid fluctuations in sodium must be avoided, saline may need to be considered
- co morbidites are more likely so screen for vascular events and sepsis
- give LMWH unless contraindicated
