Hyperosmolar Hyperglycaemic State Flashcards
what type of diabetes does hyperosmolar hyperglycaemic state occur in
Type 2
what is the difference between HHS and DKA
DKA has ketoacidosis and hyperglycaemia whereas in HHS, there is hyperglycaemia without ketoacidosis
characteristics of HHS
hyperosmolarity
hyperglycaemia (>30 mmol/L)
volume depletion
what causes HHS
insulin deficiency with increased counter-acting hormones such as cortisol, glucagon, adrenaline and GH
what are insulins counter-acting hormones
cortisol, glucagon, adrenaline and GH (growth hormone)
how would a patient with HHS present (symptoms and signs on physical examination)
acute cognitive impairment,
polyuria, polydipsia,
weight loss,
nausea,
vomitting,
weakness,
tachycardia,
hypotension
why would a patient in HHS present with hypotension (SBP <90mmHg)
due to hypovolaemia
investigations for suspected HHS
blood glucose (>30),
blood ketones (low),
Venous blood gas,
serum osmolality (high),
U&E’s
FBC (leucocytosis) and ECG (hypo/er kalaemic changes)
what does the management of hyperosmolar hyperglycaemic state depend on
SERUM POTASSIUM (low, normal, high)
management of HHS
IV fluids, IV potassium replacement (IF HYPOKALAEMIC) IV insulin, refer to ICU, monitor biomarkers
prognosis of HHS
mortality is usually quite low, seen more in elder people
risk factors for HHS
infections, inadequate insulin administration, corticosteroids etc.