Pituitary Adenoma Flashcards
(13 cards)
What is hyperosmolar hyperglycaemic state (HHS)?
A medical emergency with significant mortality (up to 20%) associated with type 2 diabetes mellitus
HHS is characterized by severe dehydration and electrolyte deficiencies due to hyperglycaemia.
What are the main consequences of hyperglycaemia in HHS?
Osmotic diuresis, severe dehydration, and electrolyte deficiencies
These consequences lead to significant clinical manifestations and complications.
In which population does HHS typically present?
Elderly individuals with type 2 diabetes mellitus (T2DM)
HHS is less common in younger individuals.
What is the pathophysiological sequence leading to HHS?
Hyperglycaemia → ↑ serum osmolality → osmotic diuresis → severe volume depletion
This sequence highlights the physiological changes that occur in HHS.
What are some precipitating factors for HHS?
- Intercurrent illness
- Dementia
- Sedative drugs
These factors can trigger or exacerbate the condition.
How does the onset of HHS differ from diabetic ketoacidosis (DKA)?
HHS comes on over many days, while DKA presents within hours
This difference impacts the severity of dehydration and metabolic disturbances.
List some clinical features of HHS.
- Clinical signs of dehydration
- Polyuria
- Polydipsia
- Lethargy
- Nausea and vomiting
- Altered level of consciousness
- Focal neurological deficits
These features reflect the systemic and neurological impact of HHS.
What laboratory findings are typically seen in HHS?
- Hypovolaemia
- Marked hyperglycaemia (>30 mmol/L)
- Significantly raised serum osmolarity (> 320 mosmol/kg)
- No significant hyperketonaemia (<3 mmol/L)
- No significant acidosis (bicarbonate > 15 mmol/l or pH > 7.3)
These findings help in diagnosing HHS and differentiating it from other conditions.
What is the estimated fluid loss in HHS?
100 - 220 ml/kg
Accurate fluid replacement is critical for management.
What type of fluid is typically used for management of HHS?
IV 0.9% sodium chloride solution
This is administered based on clinical assessment of fluid status.
When should insulin be administered in HHS management?
Only when blood glucose stops falling while giving IV fluids
This helps prevent complications associated with rapid changes in glucose levels.
What is a significant risk for patients with HHS due to hyperviscosity?
Venous thromboembolism
Patients are at an increased risk of thrombosis, necessitating prophylaxis.
Name two vascular complications that may occur due to hyperviscosity in HHS.
- Myocardial infarction
- Stroke
These complications highlight the severe risks associated with HHS.
