Hyperglycaemic Hyperosmolar Syndrome(HHS) Flashcards
what type of diabetes is HHS usually seen in
type 2
describe the pathophysiology of HHS
relative insulin deficiency brought on by precipitating factor, results in stress hormone activation and use of metabolites other than glucose, such as glycogen and protein, causing hyperglycaemia
what are some of the precipitating factors for HHS
inflammation, intoxication, iatrogenic, infarction, infection
describe why in HHS there are no/few ketone bodies
because mostly in type 2 patients, who can still produce some insulin so some glucose still present and no ketone bodies formed
what abnormal changes in biochemistry are seen in HHS
hypovolaemia(usually marked), marked hyperglycaemia(usually >30mmol/l), hyperosmolar(osmolarity >320mosmol/kg)
what effect does hyperosmolarity have on the blood
less water in blood becomes more conc.
what are some typical presenting features of HHS patients
diabetes often not known(may be), often older patients, young Afro-Caribbean, history of high refined carb intake pre-presentation, dehydration
what are the risks and complications associated with HHS
cardiovascular disease(MI or stroke), sepsis, risks if on some medication such as steroids or thiazide diuretics
what glucose and sodium levels are usually seen in HHS
glucose = higher than in DKA, usually >50mmol/l sodium = often higher normal or raised
describe the state of renal function usually seen in HHS
significant renal impairment
how do you calculate the osmolarity of a patient, and what is the normal range
2x Sodium + Urea + Glucose
normal range = 275-295
what is the mortality of HHS
10-50%
when is insulin given as treatment for HHS
if significant presence of ketone bodies >1, or if hyperglycaemia persists despite fluid treatment
(majority do NOT need insulin)
what is the key part of treatment for HHS
lots of fluids(0.9% saline), should correct hyperglycaemia, but need to be careful in patients at risk of fluid overload
what treatment is given to all HHS patients to reduce risk of complication, unless contraindicated
LMWH
