Hyperosmolar Hyperglycaemic State Flashcards
(11 cards)
What is suspected when patients present with marked hyperglycaemia (30 mmol/L or more) without significant ketosis?
Hyperglycemic Hyperosmolar State (HHS)
HHS can occur concomitantly with Diabetic Ketoacidosis (DKA)
What is the osmolality threshold for diagnosing HHS?
320 mosmol/kg or more
Osmolality is calculated as 2Na+ + glucose + urea
List four risk factors for HHS.
- Type 2 diabetes with poor glycemic control
- Advanced age
- Infections or other illnesses
- Medications that affect glucose metabolism
What severe condition results from hyperglycemia greater than 600 mg/dL?
Hyperglycemic Hyperosmolar State (HHS)
HHS is characterized by profound insulin deficiency and increased hepatic glucose production
What are the main factors contributing to HHS?
- Profound insulin deficiency
- Increased hepatic glucose production
- Osmotic diuresis leading to severe dehydration
- Hyperosmolality resulting in neurologic symptoms
What is the mainstay of treatment for HHS?
Fluid resuscitation
0.9% NaCl should be used in the first instance
What should sodium levels not be lowered by more than during treatment?
10 mmol/L per 24 hours
Sodium levels are usually high on presentation due to dehydration
Why do sodium levels initially rise during treatment for HHS?
Due to the effects of hyperglycaemia causing relative ‘pseudo-hyponatraemia’
True hypernatraemia is usually higher than initial hypernatraemia
What is the maximum rate at which glucose levels should fall?
5 mmol/L per hour
Under what conditions can insulin treatment be commenced in HHS?
If blood sugars stop falling with fluids alone or if there is significant ketosis
Significant ketosis is indicated by urine ketones 2+ or 3β-hydroxy butyrate greater than 1 mmol/L
What is the treatment of cerebral oedema in HUS?
Hypertonic saline to improve osmolarity
Mannitol infusion
