Hyperosmolar Hyperglycaemic State

Question 1

Calculate Osmolality

Answer 1

2 x sodium + urea + glucose

Question 2

What counts as hyperosmolar state?

Answer 2

osmolality over 320

Question 3

Clinical features

Answer 3

T2DM

Chronic course: over 1 week

Increasingly fatigued

Question 4

Management

Answer 4

first priority = dilute

Give fluids slowly over 48 hours
LMWH thromboprophylaxis

If glucose not falling by 5mmol/hr give fixed rate insulin infusion at 0.05 units / hour

Replace 50% fluid loss in first 12 hours

(Monitor potassium and foot care)