Hyperglycaemic Hyperosmolar State

Question 1

Which type of diabetic usually suffers from HHS?

Answer 1

Type 2

Question 2

What are some potential causes of HHS?

Answer 2

Illness, infection, non-adherence, MI

Question 3

What happens in HHS?

Answer 3

Severe hyperglycaemia increases osmolarity of the blood and so draws water out of cells. The body tries to get rid of the glucose in the urine, this is osmotic diuresis

Question 4

What are the key presentations?

Answer 4

Decreased consciousness, severe dehydration, hyperglycaemia, hyperosmolality

Question 5

What are the diagnostic criteria?

Answer 5

Glucose >11, heavy glycosuria, high plasma osmolality

Question 6

Are there any changes to ketonaemia or pH?

Answer 6

No

Question 7

Why do you give low molecular weight heparin?

Answer 7

There is a risk of occlusive events

Question 8

How do you manage HHS?

Answer 8

Fluid replacement with saline, LMWH, check and give potassium if necessary

Question 9

What should you keep the glucose at for the first 24h to prevent cerebral oedema?

Answer 9

At least 10-15 mmol per L

Question 10

What are some complications of HHS?

Answer 10

Shock, blood clot formation, cerebral oedema, lactic acidosis