Features
- Elderly
- Type 2 diabetes mellitus
- Marked hyperglycaemia
- Marked dehydration (over days)
- Altered level conc. correlates with serum osmolality
- No significant ketosis and acidosis
- Exacerbated by glucose drinks / diuretics
- Teat with GRADUAL normalisation biochemistry
- Beware co-existing medical conditions / triggers
- Beware thromboembolism
Diagnostic criteria
- Hyperglycaemia ( glucose > 30 mmol/l)
- Total osmolality > 340mOsm/kg
- Serum bicarbonate >15mmol/l
- Urinary ketones < 1+ plus
Management
- Oxygen
- ± CVP monitoring to guide fluid replacement
- NG tube if ↓ level of consciousness
- Urinary catheter
- Prophylactic heparin (Innohep), if no contraindications
- Consider insulin infusion (0.05 U/kg/hr) in all
Osmolality
[2 x (Na+ + K+) + Urea + Glu]
Usually > 350 mOsm/kg
Links
- https://emcrit.org/ibcc/hhs/
- Dhatariya KK, Vellanki P. Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS)
- Novel Advances in the Management of Hyperglycemic Crises (UK Versus USA). Curr Diab Rep. 2017;17(5):33. doi:10.1007/s11892-017-0857-4
- https://www.bjd-abcd.com/index.php/bjd/article/view/17/47
Content by Dr Íomhar O' Sullivan. Last review Dr Simon Walsh, Dr ÍOS 4/11/21.