HHS

Question 1

Explain the pathophysiology of HHS?

Answer 1

1. hyperglycaemia results in osmotic diuresis (excess urination)
2. loss of sodium and potassium
3. severe volume depletion results in hyperviscosity
4. increases risk of MI/thrombosis

Question 2

Clinical features of HHS? (general)

Answer 2

1. fatigue
2. lethargy
3. nausea and vomiting

Question 3

Clinical features of HHS? (neurological)

Answer 3

1. altered consciousness

2. headaches

Question 4

Clinical features of HHS? (CVS)

Answer 4

1. dehydration
2. hypotension
3. tachycardia

Question 5

What are 3 major goals of management?

Answer 5

1. normalise the osmolality
2. replace fluid and electrolyte losses
3. Normalise blood glucose

Question 6

What are the lab results for HHS?

Answer 6

1. hypovolaemia
2. hyperglycaemia > 30 mmol/L
3. serum osmolarity > 320 mmol/kg

Question 7

Main step of HHS management?

Answer 7

Fluid replacement with 0.9% Sodium chloride

• this alone results in gradual decline of blood glucose and osmolarity

Question 8

When should insulin be started?

Answer 8

ONLY
if signficant ketonaemia is present
otherwise
AVOID STARTING INSULIN

Question 9

What is a main complication of HHS?

Answer 9

Thrombosis due to hyperviscosity

• LMWH as a prophylaxis