Hyperosmolar Hyperglycaemic State (HSS)**** Flashcards
What type of DM is this common in?
What type of patient do they tend to be common in?
What is the triad for HHS?
Type 2 DM
It also tends to be old patients and their 1st presentation of DM
Tend to be elderly, live in a care home, don’t drink a lot so dehydrated
High glucose, Hypovolaemia and High serum osmolality - again think about the name
What does hyperglycaemia lead to?
Why do they not get ketoacidosis which is what would happen in type 1?
Osmotic shift out of cells leading to intracellular dehydration
There is basal insulin which is sufficient to stop ketogenesis, but not to reduce glucose.
What can precipitate it?
Illness or dehydration - the body is not able to cope
S+S:
Onset?
They get dehydration due to HSS. What are some S+S of dehydration?
Later on, brain dehydration occurs. What are 4 signs of this?
THERE WILL ALSO BE SIGNS OF SEVERE HYPOVOLAMEIA AND UNDERLYING INFECTION
Over several days to wks
Generalised weakness
Leg cramps
Visual impairment
Confusion
Lethargy
Focal neuro signs
Seizures
Investigations:
Diagnostic criteria:
- Over what glucose measurement? - mmol/L
- Over what serum osmolality? - mOsm/kg
- What needs to be low?
> 30 mmol/L
> 320 mOsm/kg
No significant ketosis
Management:
What obvious thing needs to be done?
What else may need to be treated?
Why is insulin given 1 hr later, given at a slower rate than in a DKA?
Rehydration with normal saline, slower than DKA (older population)
Underlying causes - usually infection
HSS is highly insulin sensitive - not needed if glucose dropping with fluids alone
Complications:
Why does cerebral oedema occur?
Why does a PE occur?
What ischaemic events could occur?
Sometimes, when you’re getting fluids again after being dehydrated, the body tries to pull too much water back into your cells. This can cause some cells to swell and rupture. The consequences are especially grave when brain cells are affected.
Hypovolaemia - blood is thicker risking clotting
MI
Stroke
