Hyperglycaemic Hyperosmolar Syndrome (HHS)

Question 1

Define Hyperglycaemic Hyperosmolar Syndrome (HHS)

Answer 1

Severe hyperglycaemia without significant ketosis; the characteristic metabolic emergency of T2DM

Question 2

Who is most commonly affected by HHS?

Answer 2

Middle-aged or elderly patients, often with undiagnosed T2DM

Question 3

Why does HHS not cause ketoacidosis like DKA?

Answer 3

Some insulin is still secreted, which prevents lipolysis and ketogenesis, but not enough to control hyperglycaemia

Question 4

What are the key symptoms of HHS?

Answer 4

(1) severe dehydration
(2) polydipsia
(3) nausea
(4) vomiting
(5) confusion
(6) stupor/coma

Question 5

What blood glucose level suggests HHS?

Answer 5

> 33.3 mmol/L

Question 6

How is serum osmolarity calculated?

Answer 6

Osmolality = 2[Na] + urea + glucose

Question 7

What serum osmolarity level confirms HHS?

Answer 7

> 320 mmol/kg

Question 8

What are key lab differences between HHS and DKA?

Answer 8

HHS
= No ketones, pH >7.3, bicarbonate >15 mmol/L

DKA
= Ketones present, pH <7.3, bicarbonate <15 mmol/L

Question 9

What is the first-line treatment in HHS?

Answer 9

IV fluid resuscitation with 0.9% NaCl (saline)

Question 10

When should insulin be considered in HHS?

Answer 10

Only if ketones >1 mmol/L or glucose is not falling adequately with fluids alone

Question 11

What complication must be prevented with fluid therapy in HHS?

Answer 11

Fluid overload, especially in elderly patients with heart disease

Question 12

What blood glucose levels usually occur in HHS
(Hyperosmolar hyperglycemic state)?

Answer 12

over 30mmol/L

Question 12

What vascular event should be screened for in HHS?

Answer 12

Silent MI (myocardial infarction) – common in elderly diabetics

Question 13

What pH and bicarbonate levels are in the diagnostic criteria of HHS (Hyperosmolar hyperglycemic state)?

Answer 13

pH>7.3
bicarb> 15mmol/L