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
