Hyperosmolar Hyperglycaemic State

Question 1

Does HHS typically occur in T1 or T2DM?

Answer 1

T2DM

Question 2

What are the precipitating factors in HHS?

Answer 2

Dementia
Sedative drugs
Intercurrent illness

Question 3

What is the difference between HHS and DKA?

Answer 3

Severe dehydration
Serum osmolality >320 mosmol/kg
No significant hyperketonaemia
No significant acidosis
Occurs over days vs DKA happens more acutely

Question 4

What are the clinical features of HHS?

Answer 4

Clinical signs of dehydration
Polyuria
Polydipsia
Lethargy
N&V
Neurological - low GCS, focal neurological deficits
Haematological - hyperviscosity

Question 5

What is the management of HHS?

Answer 5

Fluid replacement - 0.5-1L/hour depending on clinical assessment
Potassium levels to be monitoring
Insulin - not to be given unless glucose stops falling
VTE prophylaxis - due to high viscosity
Complications - MI, stroke (blood hyperviscosity)