Hyperosmolar hyperglycaemic state Flashcards
What is a Hyperosmolar Hyperglycaemia State (HHS)?
1 - elevate osmolarity of electrolytes
2 - elevated glucose in the blood
3 - reduces glucose in the blood
4 - all of the above
2 - elevated glucose in the blood
- blood glucose is high in blood
- hyperosmolality state of glucose
- associated with low or no insulin
Does Hyperosmolar Hyperglycaemia State (HHS) or diabetic ketoacidosis have a more rapid onset?
- DKA = rapid onset (hours)
- HHS = slow progressive (hours to days)
Is a Hyperosmolar Hyperglycaemia State (HHS) more common in T1DM or T2DM?
- T2DM
Hyperosmolar Hyperglycaemia State (HHS) is where the blood glucose is high in blood, resulting in a hyperosmolality state, generally associated with low or no insulin. Glucose is a polar molecule so it cannot diffuse across cellular membranes. It also draws blood from intra to extracellular space. What affect does this have on urine?
1 - ketonameia
2 - polyuria
3 - dysuria
4 - glucosuria
2 - polyuria
- body tries to reduce fluid in blood vessels
Hyperosmolar Hyperglycaemia State (HHS) is where the blood glucose is high in blood, resulting in a hyperosmolality state, generally associated with low or no insulin. Glucose is a polar molecule so it cannot diffuse across cellular membranes. It also draws blood from intra to extracellular space. What affect does this have on cells of the body?
1 - dehydrates them
2 - induces cell lysis due to lack of fluid
3 - induces cell apoptosis
4 - all of the above
1 - dehydrates them
- brain is specifically affected, causing mental issues such as confusion
A Hyperosmolar Hyperglycaemia State (HHS) is where the blood glucose is high in blood, resulting in a hyperosmolality state, generally associated with low or no insulin. How common is HHS in hospitalised diabetes patients?
1 - <1%
2 - <10%
3 - <30%
4 - >50%
1 - <1%
- 10-20% mortality
Insulin deficiency causes hyperglycaemia, which in turn can lead to increased glucose to be present in the urine, what is this called?
1 - glycosuria
2 - polyuria
3 - dysuria
4 - osmoluria
1 - glycosuria
Insulin deficiency causes hyperglycaemia, which in turn can lead to increased glucose to be present in the urine, called glycosuria. This can then lead to 2 major effects on the patient, both linked with 2 much fluid leaving the body as urine. What are these 2 effects?
1 - dehyrdation
2 - ketonaemia
3 - lipoaemia
4 - electrolyte losses
1 - dehyrdation
4 - electrolyte losses
- lost in urine
2 - electrolyte loss
Insulin deficiency causes hyperglycaemia, which in turn can lead to increased glucose to be present in the urine, called glycosuria. This can then lead to dehydration and electrolyte loss. How does hyperglycaemia cause electrolyte loss?
1 - hyperglycaemia induces hyponatraemia
2 - hyperglycaemia induces hypernatraemia
3 - hyperglycaemia induces hypokalaemia
4 - hyperglycaemia induces hyperkalaemia
1 - hyperglycaemia induces hyponatraemia
- high blood glucose increases extracellular fluid due to osmosis
- high extracellular fluid causes hyponatraemia
- diuresis is increased to reduce extracellular fluid and glucose
- electrolytes and glucose are lost
Insulin deficiency causes hyperglycaemia, which in turn can lead to increased glucose to be present in the urine, called glycosuria, which can then lead to dehydration and electrolyte loss. Long term what effect can this have on renal function?
1 - increased eGFR
2 - damaged renal tubules
3 - decreased eGFR
4 - no effect
2 - damaged renal tubules
- impaired renal function or even failure
The effects of insulin deficiency and hyperglycaemia can have a number of detrimental effects, culminating in a Hyperosmolar Hyperglycaemia State (HHS), as seen in the image. What does the ultimately lead to?
1 - liver damage
2 - shock and CV collapse
3 - brain damage
4 - renal failure
2 - shock and CV collapse
- most diabetic patients die of heart complications
A Hyperosmolar Hyperglycaemia State (HHS) is where the blood glucose is high in blood, resulting in a hyperosmolality state, which is associated with low or no insulin. Does lipolysis occur in HSS?
- no
A Hyperosmolar Hyperglycaemia State (HHS) is where the blood glucose is high in blood, resulting in a hyperosmolality state, generally associated with low or no insulin. How many of the 4 diagnostic criteria for HSS are required to confirm a diagnosis of HSS?
1 - hypovolaemia
2 - hyperglycaemia >30 mmol/L
3 - no significant hyperketonaemia
4 - osmolality >320 mosmol/kg
5 - all of the above
5 - all of the above
Are ketones raised in Hyperosmolar Hyperglycaemia State (HHS)?
- no
- there is no switch to ketone metabolism
- pH should also remain >7.3
To calculate osmolality we use the formula:
- (2 x Na+ add K+) add urea add glucose
What is the normal range for osmolality?
1 - 200-250 mmol/kg
2 - 275-295 mmol/kg
3 - 300-350 mmol/kg
4 - >400 mmol/kg
2 - 275-295 mmol/kg
