HHS (Hyperosmolar Hyperglycaemic State)

HHS (Hyperosmolar Hyperglycaemic State)

Pathology:                    Hyperosmolarhyperglycaemia with dehydration and haemoconcentration. Counter-regulatoryhormone excess with relative insulin deficit (able to switch off ketogenesisbut not to control hyperglycaemia)


Aetiology:                     Elderlywith intercurrent infections, intake of drinks with high sugar content,myocardial infarction, drugs (e.g. steroids, thiazide diuretics), non-compliancewith diabetes medications, first presentation of type 2 diabetes


Symptoms:                   Lethargy,confusion, altered consciousness, neurological symptoms


Signs:                              Dehydration,confusion, coma, polyuria, slurred speech, seizures and signs of stroke


Investigations:          Bloods: Glucose (>40 mmol/l), serumelectrolytes, serum osmolality

>350mosmol/kg),ketones, septic screen

VenousBlood Gas: pH and bicarbonate

ECG: Ruleout ischaemia or infarction

MSU: Screenfor infection

ChestX-Ray: Screen for infection


Treatment:                  IV Fluids: 8-10 litre deficit to becorrected slowly as risk of cerebral oedema

                                          Insulin: 3-5units/hr to reduce glucose ~ 5mmol/L/hr. Monitor potassium.

VTE prophylaxis:Hypercoagulable state


Complications:          Venous thromboembolism, permanentneurological sequelae


Prognosis:                    Mortality up to 50%especially in elderly


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