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Management of Hyperosmolar Hyperglycemia

Hyperosmolar Hyperglycaemic State (HHS) is a life-threatening emergency characterized by severe hyperglycemia, hyperosmolarity, and dehydration without ketoacidosis, commonly triggered by infections. Diagnosis involves specific plasma glucose and serum osmolality levels, while management focuses on fluid replacement, correcting hyperglycemia, and addressing the underlying cause. Complications can include cerebral edema and vascular issues, necessitating careful monitoring and treatment.

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684 views14 pages

Management of Hyperosmolar Hyperglycemia

Hyperosmolar Hyperglycaemic State (HHS) is a life-threatening emergency characterized by severe hyperglycemia, hyperosmolarity, and dehydration without ketoacidosis, commonly triggered by infections. Diagnosis involves specific plasma glucose and serum osmolality levels, while management focuses on fluid replacement, correcting hyperglycemia, and addressing the underlying cause. Complications can include cerebral edema and vascular issues, necessitating careful monitoring and treatment.

Uploaded by

Lodrick Kato
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

Hyperosmolar Hyperglycaemic

State
• By: Tuan Mohd Amirul Hasbi Bin Tuan Pail
Introduction
• • Life-threatening emergency
• • Less severe than DKA
• • Previously HHNKC
• • Common trigger: infection
• • Features: Hyperglycemia, Hyperosmolarity,
Dehydration, No ketoacidosis
Diagnostic Features
• • Plasma Glucose: >600 mg/dL
• • Serum osmolality: >320 mOsm/kg
• • Dehydration: >9L
• • pH: >7.3
• • Bicarbonate: >15 mEq/L
• • Small ketonuria
• • Altered consciousness
Aetiology
• • Type 2 DM
• • Old age, isolated living
• • No access to treatment
• • Infections, trauma, CVA, MI
• • Alcohol, vomiting/diarrhea
• • Drugs: Thiazides, Steroids, Antipsychotics,
Antiarrythmics, Antiepileptics,
Antihypertensives
Symptoms
• • Confusion, weakness
• • Polyuria, polydipsia, polyphagia
• • Vomiting, dry skin
• • Seizures, fever
Physical Examination
• • Vitals: Tachycardia, hypotension, tachypnea
• • Dehydration signs
• • Diabetes signs: Fingerpricks, ecchymoses,
obesity, acanthosis nigricans, dermopathy,
dental issues, thrush, cataracts
Dehydration Assessment
• • 1L fluid loss = 1kg weight loss
• • Skin turgor, dryness
• • Dry mouth, lethargy
Complications
• • Cerebral edema
• • ARDS
• • Vascular complications
• • Hypoglycemia, hyperglycemia
Differential Diagnoses
• • Diabetes insipidus
• • DKA
• • Myocardial infarction
• • Pulmonary embolism
Management Goals
• 1. Fluid replacement
• 2. Correct hyperglycemia
• 3. Electrolyte correction
• 4. Treat underlying cause
• 5. Monitor vital organ functions
Fluid Replacement
• • Large volume infusion
• • Start with 0.9% saline – 2L in 2 hours
• • Shift to 0.45% saline
• • Add 5% dextrose when glucose normalizes
• • Monitor for overload in renal/cardiac
compromise
Insulin Therapy
• • Continuous IV infusion
• • Exclude hypokalemia
• • Bolus 0.15 u/kg → 0.1 u/kg/hr
• • Reduce to 0.05 u/kg/hr at 300 mg/dL
• • Add 5% dextrose
• • Switch to oral intake when stable
Potassium Replacement
• • Hyperkalemia common
• • Insulin & fluids lower K+
• • Monitor serum K+
• • If <5 mEq/L and urine output is good, give
20-30 mEq/L K+
Treat the Cause
• • Identify and manage the underlying
condition

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