Hyperosmolar hyperglycaemic state

Question 1

What is hyperosmolar hyperglycaemic state?

Answer 1

A complication of diabetes, characterised by hyperglycaemia and hyperosmolality of the blood, in the absence of ketones

Question 2

What is the clinical definition of hyperosmolar hyperglycaemic state?

Answer 2

Marked hyperglycaemia (>30mmol/L), without significant ketosis (<3 mmol/L), or acidosis (pH>7.3)

Osmolality 320 mosmol/kg or more

Question 3

What are the risk factors for hyperosmolar hyperglycaemic state?

Answer 3

Poorly controlled diabetes
Advanced age
Infections or other illnesses
Medications that affect glucose metabolism

Question 4

What are the symptoms of hyperosmolar hyperglycaemic state?

Answer 4

Profound dehydration
Dry mucous membranes
Altered mental status
Neurological symptoms - seizures or focal neurological deficits
Hypotension
Tachycardia

Question 5

What investigations are used in the diagnosis of hyperosmolar hyperglycaemic state?

Answer 5

Blood glucose levels
Serum osmolality
U&Es
Urinalysis for ketones

Question 6

What is the management of hyperosmolar hyperglycaemic state?

Answer 6

Fluid resuscitation 0.9% NaCl
Insulin can be given if blood sugars stop falling with fluids alone

Question 7

What are the complications of hyperosmolar hyperglycaemic state?

Answer 7

Hypovolaemic shock
Cerebral oedema
Thromboembolic events
AKI
Cardiac arrhythmias
Respiratory failure
Long term neurological effects