Hyperosmolar Hyperglycaemic State

Question 1

Characteristic of ?, a severe hyperglycaemia causes a hyperosmolar
state in the absence of severe ?.
o Even a small amount of ? is sufficient to prevent ketosis.
Typically occurs in the ?, often with undiagnosed ?.

Answer 1

T2
ketosis
insulin
elderly
T2

Question 2

Precipitating factors;
o Consumption of ?-rich ?.
o Medications: ? diuretics, ?, ?-blockers.
o intercurrent illness: ?/ ?.

Answer 2

glucose
drinks
thiazide
steroids
b
infection
mi

Question 3

These patients may be more severely ? than DKA patients, but
there will be no raised ?.
o Can be a ? ?, but is generally mild.
Features;
o ?.
o Stupor / ? / ?.
o Evidence of an underlying ?.

Answer 3

dehydrated
ketones
lactic acidosis
dehydration
coma/seizures
illness

Question 4

Diagnosis;
o Confirm by calculating ?;
• 2 (?+)+ ?+ ?.
o Normal osmolality is 280-295.
o Values >? suggest HHG.

Answer 4

osmolality
na
glucose
urea
320

Question 5

Management;
o Aggressive IV ?.
• ?L ? ? over ? hour.
• Aim for positive balance of ?-?L over ?hours. . .
• There may be an initial rise in ?, this is not concerning if osmolality is ?.

Answer 5

fluids
1
normal saline
1
3-6
12
na
declining

Question 6

Mx
o ? dose fixed dose IV ? Infusion.
• If there some ?: treat as per DKA and start immediately.
• If no ?: add ? once fall in glucose is

Answer 6

low
insulin
ketones
ketones
insulin
5

Question 7

Mx
o Consider ? replacement.
• If 3.5-5.5: add ?mmol / L.
• If >?: seek ? help.

o Complete normalisation of fluid/ electrolytes may take ? hours

Answer 7

K
40
senior
72

Question 8

Mx

o Give prophylactic ?.
• Very high risk of ?.
o Regular monitoring of ?, fluid ?, ?, ?, ? - hourly for the first ? hours.

Answer 8

LMWH
clot
osmolality
balance
glucose
vitals
U+Es
6

Question 9

Mx

o Transfer to ? ? when eating and drinking normally and biochemistry has normalised.
• Stop the IV infusion ? hour(s) after starting ? insulin.
o Refer to the ? team.
• Transfer to tablet/ diet treatment may be possible.

Answer 9

sc insulin
1
SC
DM