Hyperglycaemic hyperosmolar state

Question 1

what is the main complication of HHS?

Answer 1

stroke - osmotic diuresis causes hyper viscosity blood

Question 2

why is insulin contraindicated in the management of HHS?

Answer 2

rapidly decreasing glucose will draw water into the extracellular space resulting in circulatory collapse

Question 3

what are the diagnostic features of HHS?

Answer 3

hypovolaemia 
significant hyperglycaemia (>30)
significantly raised serum osmolarity (> 320)

Question 4

what are the average fluid loss in HHS?

Answer 4

100 - 220 ml/kg

10-20 litres in a 100kg patient

Question 5

how is HHS treated?

Answer 5

fluids - 0.9% NaCl

slow infusion, aim to restore 50% within 12 hours and the remaining fluid in the 12 hours

Question 6

why does Na rise when treating HHS?

Answer 6

reduction in serum osmolarity will cause a shift in fluid into the intracellular space which will initially rise Na
for every 5.5 decrease in glucose, a safe rise in Na is up to 2.4
> 2.4 = insufficient fluid

Question 7

at what rate should you aim glucose to decrease?

Answer 7

4 - 6 mmol/hr

don’t exceed > 10 mmol in 24 hours