Hyperosmolar Hyperglycaemic State Flashcards
What is Hyperosmolar Hyperglycaemic State (HHS)?
HHS is a medical emergency characterized by severe hyperglycaemia, osmotic diuresis, dehydration, and electrolyte deficiencies, with a mortality rate of up to 20%.
Who typically presents with HHS?
HHS typically presents in the elderly with type 2 diabetes mellitus (T2DM).
What is the pathophysiology of HHS?
Hyperglycaemia leads to increased serum osmolality, resulting in osmotic diuresis and severe volume depletion.
What are common precipitating factors for HHS?
Common precipitating factors include intercurrent illness, dementia, and sedative drugs.
How does the onset of HHS differ from DKA?
HHS develops over many days, leading to more extreme dehydration and metabolic disturbances compared to DKA, which presents within hours.
What are the clinical features of HHS?
Clinical features include polyuria, polydipsia, lethargy, nausea, vomiting, altered level of consciousness, and focal neurological deficits.
What are the typical diagnostic criteria for HHS?
Typical diagnostic criteria include hypovolaemia, marked hyperglycaemia (>30 mmol/L), significantly raised serum osmolarity (>320 mosmol/kg), no significant hyperketonaemia (<3 mmol/L), and no significant acidosis (bicarbonate > 15 mmol/L or pH > 7.3).
How is serum osmolarity calculated?
Serum osmolarity can be calculated using the formula: 2 * Na+ + glucose + urea.
What is the management for HHS?
Management includes fluid replacement, monitoring potassium levels, administering insulin only if blood glucose stops falling, and venous thromboembolism prophylaxis.
What is the estimated fluid loss in HHS?
Fluid losses in HHS are estimated to be between 100 - 220 ml/kg.
What complications may arise from HHS?
Complications include vascular issues due to hyperviscosity, such as myocardial infarction and stroke.
