Hyperglycaemic hyperosmolar state

Question 1

pathophysiology HHS?

Answer 1

↑ glucose in T2DM
osmotic shift leads to dehydration
(classically insidious onset)
no ketones (some basal insulin)
pH stays >7.3

Question 2

Sx HHS?

Answer 2

onset over days - 1 week
weak
leg cramps
visual impairment
infection + ↓BP
bad: confusion, lethargy, neuro Sx

Question 3

diagnostic criteria HHS?

Answer 3

glucose >30
osmolality >320
ketones LESS than 3/+++

Question 4

Ix HHS?

Answer 4

BEDSIDE - BM, finger prick ketones, ECG (pre-renal AKI and K+ risk)

BLOODS - osmolality, ketones, glucose, usuals (LFTs, etc), ABG (normal)

IMAGING - CXR/look for cause of infection

Question 5

Tx HHS?

Answer 5

• rehydrate! (slower than DKA as often older and oedema risk as more fluid depleted than DKA)
• **VTE prophylaxis
• Tx precipitant (infection, etc)

only Tx with insulin if BM not falling by 5mmol/L/hr with rehydration (at 0.05 units/kg/hr)

Question 6

complications HHS?

Answer 6

**cerebral oedema
**occlusive events: focal CNS Sx, chorea, DIC, leg ischaemia, rhabdomyolysis)
- PE
- ischaemia (MI, stroke)
>10% mortality than DKA (bc older, iller)