Editing Hyperosmolar hyperglycaemic state


'''Non-ketotic hyperglycaemia (Hyperosmolar Hyperglycaemic State - HHS)'''
* Severe hyperglycaemia without ketosis
* Typically occurs in patients with T2DM who have enough endogenous insulin to prevent ketogenesis, but not enough to maintain normoglycaemia (BSL >30-50)
* Usually precipitated by infection, MI, stroke or trauma
* Glycosuria is marked, and the resulting osmotic diuresis results in hypovolaemia
* The combination of hyperglycaemia and hypotonic fluid loss produces a considerable increase in plasma osmolality
* Plasma sodium is an unreliable marker of ECV because of the dilutional effect of hyperglycaemia
* For every increase by 5 of the BSL above 5, the plasma sodium concentration will decrease about 2mEq/L
* Mortality rate is higher than in DKA!
* '''Presentation'''
** BSL > 30-50
** Minimal ketosis
** Hypovolaemia
** Precipitating event
** Obtundation occurs more frequently with HHS than DKA, because of the higher degree of hyperosmolality
* '''Management'''
** Aggressive IVF resuscitation with isotonic fluids - 1-2L in first hour, guided by usual metrics
** Withhold insulin until vascular volume is restored (insulin draws both glucose and water into cells, so can aggravate hypovolaemia)
** Insulin requirement will decrease as the hypertonic condition is corrected - monitor BSL closely

[[Category:Endocrinology]]