hyperosmolar hyperglycemic state (HHS) Flashcards
What is HHS also known as?
Hyperosmolar hyperglycemic state or hyperosmotic hyperglycemic nonketotic state
What is the plasma glucose level that meets the criteria for HHS?
> 600 mg/dL (>33.3 mmol/L)
What is the effective serum osmolality that indicates HHS?
> 320 mOsm/kg (>320 mmol/kg)
What arterial pH level is associated with HHS?
> 7.30
What is the serum bicarbonate level indicative of HHS?
> 18 mEq/L (>18 mmol/L)
What are the characteristics of dehydration in HHS?
Severe dehydration with minimal or no ketoacidosis
Name a common precipitating factor of HHS.
Infection (e.g., pneumonia, urinary tract infection)
What is another common precipitating factor of HHS?
Discontinuation or inadequate insulin therapy
What is the initial fluid replacement for HHS?
Isotonic 0.9% NaCl at a rate of 15 to 20 mL/kg over the first hour
How should fluids be adjusted in HHS treatment?
Based on volume status and corrected serum sodium
What alternative fluid can be used if necessary in HHS treatment?
0.45% NaCl
What should be avoided when treating HHS with saline?
Hypertonic saline (3.0% NaCl) may worsen hypernatremia and hyperosmolarity
What is the initial bolus dose of intravenous insulin for HHS?
10 units
What is the continuous infusion rate of insulin for a patient weighing 220 lb (100 kg)?
10 units per hour
What is an alternative method for starting insulin infusion in HHS treatment?
Omit bolus and start continuous infusion at 0.14 units/kg per hour
