Hyperosmolar Hyperglycaemic State

Question 1

what type of diabetes does hyperosmolar hyperglycaemic state occur in

Answer 1

Type 2

Question 2

what is the difference between HHS and DKA

Answer 2

DKA has ketoacidosis and hyperglycaemia whereas in HHS, there is hyperglycaemia without ketoacidosis

Question 3

characteristics of HHS

Answer 3

hyperosmolarity

hyperglycaemia (>30 mmol/L)

volume depletion

Question 4

what causes HHS

Answer 4

insulin deficiency with increased counter-acting hormones such as cortisol, glucagon, adrenaline and GH

Question 5

what are insulins counter-acting hormones

Answer 5

cortisol, glucagon, adrenaline and GH (growth hormone)

Question 6

how would a patient with HHS present (symptoms and signs on physical examination)

Answer 6

acute cognitive impairment,

polyuria, polydipsia,

weight loss,

nausea,

vomitting,

weakness,

tachycardia,

hypotension

Question 7

why would a patient in HHS present with hypotension (SBP <90mmHg)

Answer 7

due to hypovolaemia

Question 8

investigations for suspected HHS

Answer 8

blood glucose (>30),

blood ketones (low),

Venous blood gas,

serum osmolality (high),

U&E’s

FBC (leucocytosis) and ECG (hypo/er kalaemic changes)

Question 9

what does the management of hyperosmolar hyperglycaemic state depend on

Answer 9

SERUM POTASSIUM (low, normal, high)

Question 10

management of HHS

Answer 10

IV fluids, IV potassium replacement (IF HYPOKALAEMIC) IV insulin, refer to ICU, monitor biomarkers

Question 11

prognosis of HHS

Answer 11

mortality is usually quite low, seen more in elder people

Question 12

risk factors for HHS

Answer 12

infections, inadequate insulin administration, corticosteroids etc.