Hyperosmolar Hyperglycaemic State (HHS)

Question 1

What is the definition of HHS?

Answer 1

Marked hyperglycemia, hyperosmolality, mild/no ketoacidosis

Often precipitated with infection (eg, pneumonia)

Medical emergency- serious complication of T2DM

Question 2

What is the aetiology of HHS?

Answer 2

Untreated/undiagnosed T2DM
Infection/illness

Question 3

Pathology of HHS

Answer 3

Low insulin = excessive hepatic gluconeogenesis (not completely insulin deficient therefore inhibits ketogenesis)

Glucose: osmotically active therefore excessive glucose = hyperosmolar blood

Hyperglycemia- osmotic diuresis- dehydration

Question 4

Symptoms of HHS

Answer 4

Severe T2DM
Confusion & reduced mental state (related to plasma osmolality)
Legarthy and severe dehydration

Question 5

Diagnosis of HHS

Answer 5

RPG >11mmol/L
Plasma osmolality high >300mmol/L
Urine dipstick = glycosuria but No ketonuria
U+Es =increased serum K+

Question 6

What is the treatment for HHS?

Answer 6

Replace fluid - 0.9% saline IV
Then IV insulin (at slow infusion rate)
Restore electrolytes (K+)
LMWH (low molecular weight heparin) - anticoagulase patient as they have thicker blood

Question 7

Macrovascular complications of type 1 & 2 DM?

Answer 7

Cardiovascular (MI)
Cerebrovascular (ischemic stroke)
Peripheral vascular disease (PVD)

Question 8

Microvascular complications of Type 1 & 2 DM?

Answer 8

Retinopathy, neuropathy (eg, charcots foot), nephropathy (nephrotic syndrome CDK)