HHS

Question 1

What is HHS?

Answer 1

Hyperosmolar hyperglycaemic state

MEDICAL EMERGENCY

Question 2

What is the pathophysiology?

Answer 2

Severe hyperglycaemia = osmotic diuresis = severe vol. depletion = raised serum osmolarity = hyperviscosity of blood = dehydration

Question 3

Why might a pt not look as dehydrated as they are?

Answer 3

Hypertonicity leads to preservation of intravascular vol.

Question 4

Which dep should HHS be mx in?

Answer 4

ICU - labour intensive RX

Must differentiate from DKA as RX very different

Question 5

How does it present?

Answer 5

Fatigue, lethargy, N/V
Altered consciousness, headaches, papilloedema, weakness
Hypervicosity (MI, stroke)
Dehydration, hypoTN, tachycardia

Question 6

What criteria dx and distinguishes HHS from DKA?

Answer 6

1 - Hypovalaemia
2 - Marked hyperglycaemia >30 mmol/L w/out sig ketonaemia or acidosis
3 - Significantly raised serum osmolarity (>320 mOsmol/kg)

Question 7

How is it mx?

Answer 7

IV 0.9% NaCl
- If osmolarity not declining reduce to 0.45%

Monitor response to RX

Only start insulin if significant ketonaemia, otherwise DON’T

Replace K as required