Hyperosmolar hyperglycemic state tins

Question 1

Hyperosmolar hyperglycemic state

Answer 1

HHS. Progressive hyperglycemia and hyperosmolarity typically in NIDDM, with limited access to water and commonly a precipitating illness

Question 2

3 main factors causing HHS

Answer 2

1. Insulin resistance/deficiency
2. Inflammatory state with marked elevation in proinflammatory cytokines (C-reactive protein, interleukins, tumor necrosis factors) and counterregulatory hormones (gH, cortisol) that cause hepatic gluconeogenesis and glycogenolysis
3. Osmotic diuresis followed by impaired renal excretion of glucose

Question 3

Osmotic diuresis

Answer 3

Increased urination due to substance in fluid filtered by kidney which pulls water

Question 4

Gluconeogenesis

Answer 4

Formation of glucose from not sugar

Question 5

Glycogenolysis

Answer 5

Breakdown of glucose

Question 6

Patho of HHS

Answer 6

Extra sugar pulls fluid from intracellular to intravascular,, temporarily increasing GFR, eventually kidneys can’t keep up with sugar and glucosuria and osmotic diuresis occur
Osmotic diuresis can cause significant loss of Na+ and K+, as well as modest losses of Ca2+, phosphate and Mag.
Volume depletion occurs, renal perfusion decreases, and GFR is reduced

Question 7

Why don’t HHS pts get DKA

Answer 7

Not sure. But possibly

1. High levels of endogenous insulin inhibit lipolysis
2. Lower levels of counterregulatory stress hormones
3. Inhibition of lipolysis by hyperosmolar state

Question 8

Clinical presentation of HHS

Answer 8

Old AF with NIDDM and comorbid conditions, often referred by caretaker for fever, abnormal vitals and or mental changes that have evolved over days/weeks
Weakness, anorexia, fatigue, dyspnea, chest or abdo pain.
Hx of pneumonia or UTI. Underlying cardiovascular, renal and neuro disease
Antipsychotics or lithium pose a significantly high risk

Question 9

Physical exam in HHS

Answer 9

Poor skin turgor, dry mucous membranes, sunken eyes, hypotension
Normo or hypothermia due to vasodilation
15% have seizures, usually generalized
Hypokalemia hyponatremia

Question 10

TX HHS

Answer 10

Fluid, correct lytes, gradual correction of hypergylcemia and hyperosmolarity

Question 11

Complications of HHS

Answer 11

Cerebral edema in children, uncommon in adults