Hyperosmolar hyperglycaemic state Flashcards

1
Q

What is hyperosmolar hyperglycaemic state?

A

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

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2
Q

Who is HHS most common in?

A

People present in middle or later life, often with previously undiagnosed diabetes

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3
Q

What are some precipitants of HHS?

A
  • Infection
  • Stroke or MRI
  • Trauma or compromised water intake (Elderly)
  • Hyperthyroidism, acromegaly or hypercortisolism
  • Iatrogenic (steroids)
  • Non-compliance
  • Newly diagnosed diabetes
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4
Q

Why does HHS occur (And DKA doesn’t) in T2DM?

A
  • Pathophysiology is similar to DKA, but HHS, there are stillsmall amounts of insulinbeing secreted by the pancreas
  • This is sufficient toprevent DKA by suppressing lipolysis and, in turn, ketogenesis, but level is not high enough to lower blood glucose to a safe level
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5
Q

How does HHS present?

A
  • Dehydration due to polyuria
  • Polydipsia
  • Nausea and vomiting
  • Stupor/coma (Impaired consciousness is directly related to degree of osmolarity)
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6
Q

What glucose level defines HHS?

A

Profound hyperglycaemia (glucose >33.3mmol/L)

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7
Q

What serum osmolarity defines HHS?

A

Hyperosmolality (serum osmolarity >320mmol/kg)

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8
Q

What are some investigation findings in HHS?

A
  • Profound hyperglycaemia
  • Hyperosmolarity
  • Significant renal impairment
  • Hypernatraemia (Or high end of normal)
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9
Q

What are some management options in HHS?

A
  1. 0.9% saline for fluid replacement (No insulin)
  2. Monitor BG, osmolarity and sodium
  3. Start low dose insulin only if significant ketones
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10
Q

What are some managements of co-morbidities in HHS?

A
  • Screen for vascular event e.g. silent MI
  • LMWH for all patients (unless contraindicated)
  • High risk of feet complications
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11
Q

How does HHS differ from DKA?

A
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12
Q
A
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