HSS Flashcards
What is hyperosmolar hyperglycaemic state (HHS)?
A medical emergency characterized by hyperglycaemia, osmotic diuresis, severe dehydration, and electrolyte deficiencies seen in T2DM
What is the mortality rate associated with HHS?
Up to 20%.
Which population is typically affected by HHS?
Elderly individuals with type 2 diabetes mellitus (T2DM).
What is the pathophysiological sequence leading to HHS?
Hyperglycaemia → ↑ serum osmolality → osmotic diuresis → severe volume depletion.
What are some precipitating factors of HHS?
- Intercurrent illness
- Dementia
- Sedative drugs
How does the onset of HHS differ from DKA?
HHS comes on over many days, while DKA presents within hours.
What are common clinical features of HHS?
- Polyuria
- Polydipsia
- Lethargy
- Nausea and vomiting
- Altered level of consciousness
- Focal neurological deficits
What haematological complication may occur due to HHS?
Hyperviscosity, which may result in myocardial infarctions, stroke, and peripheral arterial thrombosis.
What are typical diagnostic criteria for HHS?
- Hypovolaemia
- Marked hyperglycaemia (>30 mmol/L)
- Significantly raised serum osmolarity (>320 mosmol/kg)
- No significant hyperketonaemia (<3 mmol/L)
- No significant acidosis (bicarbonate > 15 mmol/l or pH > 7.3)
How is serum osmolarity calculated?
(2 x Na+) + glucose + urea.
What is the estimated fluid loss in HHS?
Between 100 - 220 ml/kg.
What type of fluid is typically administered for HHS management?
IV 0.9% sodium chloride solution.
At what rate is IV fluid typically given in HHS management?
0.5 - 1 L/hour depending on clinical assessment.
When should insulin be administered in HHS treatment?
Should not be given unless blood glucose stops falling while giving IV fluids.
What prophylaxis should be considered in HHS patients?
Venous thromboembolism prophylaxis due to risk of thrombosis from hyperviscosity.
What vascular complications may occur due to hyperviscosity in HHS?
- Myocardial infarction
- Stroke
