Hyperosmolar Hyperglycaemic State (HHS)

Question 1

What is DKA most common?

Answer 1

T1

Question 2

What is HHS most common?

Answer 2

T2

Question 3

What is the patho of HHS?

Answer 3

Hyperglycaemis but no ketonaemia as still some insulin to supress ketogenesis and dehydration causes increased osmolarity

Question 4

What is the cause of HHS?

Answer 4

1. Initial presentation
2. Infection/other acute illness
3. Non adherence to diabetes med

Question 5

What are symptoms and signs of HHS?

Answer 5

1. Collapse/confusion
2. Dehydrated
3. Kussmaul breathing
4. NO ABDO PAIN (DKA)
5. Nausea
6. Vomiting

Question 6

What is ketone level in HHS?

Answer 6

<3mmol/L

Question 7

What is pH in HHS?

Answer 7

normal (7.35-7.45)

Question 8

What is plasma glucose is HHS?

Answer 8

> 30

Question 9

What is the management plan of HHS?

Answer 9

1. Fluids started (normal saline) + KCL (if K+<5.5)
2. Iv insulin after fluids only when K+ not <3.5
3. Include dextrose in fluid if it falls <14
4. Treat underlying cause e.g. Abx

Question 10

What does insulin do?

Answer 10

drives potassium into cells