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Other causes of HHS?

MI, infection, stroke, hyperthermia, burns, GI bleed, pancreatitis, AKI, metformin, diuretics, bbs, dialysis, ccb, diabetes, poor diabetic control


Prevalence of HHS?

low incidence but increasing prevalence due to the increase in DM2


Risk factors for HHS?

DM2, elderly, nursing home residents, dementia, sedative drugs, heat waves, propensity to infection, children with long term steroid use or gastroenteritis


Presentation of HHS?

generalised weakness, leg cramps, visual impairment, nausea, vomiting, bed bound, confused, lethargic, reduced endogenous insulin levels, focal neurological symptoms, seizures, coma, dehydration, tacycardia, hypotension, Increased RR, Hb desaturation, hypothermia


DD of HHS?

lactic acidosis - when blood lactate is >5mmol/L (a rare complication of metformin)


Investigations of HHS?

marked glycosuria, plasma glucose >30mmol/L, serum osmolarity is >320mmol/L, AKI, cultures to test for infection, pH >7.3,


Management aims of HHS?

treat underlying cause, replace fluid and electrolyte loss, normalise blood glucose, prevent and assess complications


Initial HHS management?

ABC, resuscitation, ventilate, IV access, ECG monitor, SaO2 monitor, BP monitor, O2, catheterise, nasogastric tube, ICU, alert diabetic team, LWMH


Management of HHS?

calculate osmolality, fluids and electrolytes, a fall in blood glucose of 5mmol/L/hour , low dose IV insulin after, drink as soon as it is safe, fluid balance chart, replace K+ when urine flows


Complications of HHS?

higher mortality than DKA with vascular complications, MI, stroke, peripheral arterial thrombosis, seizures, cerebral oedmea, ischemia, infarction, DVT, PE, ARDS, DIC, multi organ fialure, rhabdomyolysos, cerebral oedema

mortality is high but improved, raise awareness