Hyperosmolar hyperglycaemic state

Question 1

HHS triad

Answer 1

severe hyperglycaemia (>=30mmol/L)

hypotension

hyperosmolality (usually >320 mosmol/kg).

(no acidosis or ketosis)

Question 2

Why no acidosis or ketosis in HHS compared to DKA

Answer 2

presence of endogenous insulin production in Type 2 diabetics is sufficient to ‘switch off’ ketone production and prevent diabetic ketoacidosis.

Question 3

Causes of HHS in T2DM

Answer 3

Infection
Medications that cause fluid loss or lower glucose tolerance
Surgery
Impaired renal function

Question 4

Mx of HHS

Answer 4

1. fluid replacement
   fluid losses in HHS are estimated to be between 100 - 220 ml/kg
   IV 0.9% sodium chloride solution
   typically given at 0.5 - 1 L/hour depending on clinical assessment
   potassium levels should be monitored and added to fluids depending on the level
2. insulin –> should not be given unless blood glucose stops falling while giving IV fluids
3. venous thromboembolism prophylaxis
   patients are at risk of thrombosis due to hyperviscosity