Hyperosmolar hyperglycaemic state Flashcards
1
Q
What is hyperosmolar hyperglycaemic state?
A
Severe hyperglycaemia without significant ketosis; the characteristic metabolic emergency of T2DM
2
Q
Who is HHS most common in?
A
People present in middle or later life, often with previously undiagnosed diabetes
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
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
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)
6
Q
What glucose level defines HHS?
A
Profound hyperglycaemia (glucose >33.3mmol/L)
7
Q
What serum osmolarity defines HHS?
A
Hyperosmolality (serum osmolarity >320mmol/kg)
8
Q
What are some investigation findings in HHS?
A
- Profound hyperglycaemia
- Hyperosmolarity
- Significant renal impairment
- Hypernatraemia (Or high end of normal)
9
Q
What are some management options in HHS?
A
- 0.9% saline for fluid replacement (No insulin)
- Monitor BG, osmolarity and sodium
- Start low dose insulin only if significant ketones
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
11
Q
How does HHS differ from DKA?
A
12
Q
A