Hyperosmolar hyperglycaemic state Flashcards
What is HHS
associated with T2DM
no ketoacidosis occurs as there is still little insulin production
Hyperglycaemia results in osmotic diuresis, severe dehydration and electrolyte deficiencies
What is the pathophysiology of HHS
hyperglycemia leads to an increase in serum osmolality which then leads to osmotic diuresis which results in severe volume depletion
What is the triad of HHS
hyperglycaemia with no ketoacidosis
hypovolaemia
hyperosmolality
What is HHS caused by
infetion / acute illness
non-adeherence to diabetes medication
What would a patient with HHS present with
gradual onset of ..
Nausea and vomitting
polyuria and polydipsia
dehydration
hyperventilation
collapse/confusion
hyperviscosity
What investigations are required and what would they show
Ketones <3mmol/L
normal pH
plasma glucose >30
Raised serum osmolarity-
What is the management
first line is fluid resuscitation - 0.9% saline
saline and potassium chloride if potassium <5.5
IV insulin only if blood glucose stops falling while fluids are being given
VTE prophylaxis - due to hyperviscosity at risk of thrombosis
treat underlying cause- eg broad spectrum antibiotics
urinary catheter - to monitor urine output
What are some complications
vascular complication may occur due to hyperviscosity
-MI
-Stroke
What immediate investigation may be required
capillary glucose - immediate assessment of confusion as prolonged hypoglycemia can result in permanent neurological damage
What kind of patients are usually at risk of HHS
elderly patients with undiagnosed T2DM
history is usually about a week , with marked dehydration and blood glucose >35mM
Acidosis is absent
How can serum osmolarity be calculated
2 x sodium +glucose+urea
> 320 mosmol/kg is typically seen in a patient with HHS
