Hyperosmolar Hyperglycaemic State

Question 1

What happens in HHS

Answer 1

Hyperglycaemia leads to osmotic diuresis which is excreted in large volumes of urine. This causes severe volume depletion and electrolyte imbalances- making HHS a medical emergency

Question 2

What causes HHS

Answer 2

• Infection e.g. pneumonia, UTI
• Dementia/cognitive impairment
• Sedative drugs
• Acute illness e.g. stroke/MI

Question 3

What are the clinical features of HHS

Answer 3

Typically affects older T2DM patients and develops over the course of days
- Dehydration
- Cognitive impairment e.g. confusion
- Polydipsia, polyuria
- Lethargy, weakness
- N&V
- Blood clots due to hyper viscosity

Question 4

What investigations are done in HHS

Answer 4

• hypovolaemia
• marked hyperglycaemia (>30 mmol/L)
• significantly raised serum osmolarity (> 320 mosmol/kg) - can be calculated by: (2Na + glucose + urea)
• no significant hyperketonaemia (<3 mmol/L)
  no significant acidosis (bicarbonate > 15 mmol/l or pH > 7.3 – acidosis can occur due to lactic acidosis or renal impairment)
• Hypernatremia - indicates severe dehydration

Question 5

How do we manage HHS

Answer 5

1. IV fluid resus: 1L 0.9% sodium chloride over 1 hour
2. FRII
3. Identify and treat underlying cause
4. Correct electrolytes e.g. add KCl if hypoK
5. VTE prophylaxis

Question 6

What are the complications from HHS

Answer 6

MI or stroke due to hyper viscosity