Hyperosmolar hyperglycaemic state (HHS)

Question 1

What is HHS a rare but serious complication of?

Answer 1

T2DM

Question 2

What does hyperosmolality mean in the context of T2DM?

Answer 2

The concentration of solutes ie. glucose in the blood is much higher than normal due to hyperglycaemia.
Therefore, higher number of dissolved particles in the blood so more osmoles per kilogram of solvent.

Question 3

True of false: there is a high concentration of ketones in hyperosmolar hyperglycaemic state?

Answer 3

False
The absence of ketones distinguishes it from ketoacidosis.

Question 4

How come ketones aren’t present yet the patient is in a hyperglycaemic state?

Answer 4

Patient is not totally insulin deficient so ketogenesis doesn’t occur yet there is excessive hepatic gluconeogenesis causing hyperglycaemia.

Question 5

What are presentations of HHS?

Answer 5

Polyuria
Polydipsia
Dehydration
Weight loss (especially due to loss of water)
Tachycardia
Hypotension (decreased blood volume)
Confusion
Loss of consicousness

Question 6

Why does HHS cause tachycardia?

Answer 6

Lower volume of blood means there is a decreased preload in the heart. In order to perfuse all the organs well and maintain the cardiac output, the heart increases it’s rate of contraction.

Question 7

How do you diagnose HHS?

Answer 7

Heavy glucosuria
Increased plasma osmolarity (more than 300 mmol/l)
No ketonuria
Not hyperketonemic

Question 8

How do you treat HHS?

Answer 8

First insulin
then IV fluids
LMWH (anticoag as thicker blood)
Careful monitoring

Question 9

What often will precipitate HHS in T2 diabetics?

Answer 9

An infection like pneumonia