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Hyperosmolar Hyperglycaemic State

Pathophysiology

Clinical assessment and risk stratification

Goals of treatment

Insulin dose and timing

Anti-infective therapy

Anticoagulation

Other electrolyte imbalances and complications associated with HHS

Hyperosmolar Hyperglycaemic State – Post Test

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Hyperosmolar Hyperglycaemic State – Post Test

Hyperosmolar Hyperglycaemic State
Hyperosmolar Hyperglycaemic State – Post Test

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Question 1 of 10

1. Question

Which is usually a feature of HHS?

Seen mainly in type 1 diabetics
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Serum osmolality 275-295mmol/l
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Fluid deficit usually less than that in DKA
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Glucose usually more than that in DKA
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Metabolic acidosis
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Question 2 of 10

2. Question

Which is not true about HHS?

PH of patient will be usually > 7.3
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Total body potassium is not reduced as in DKA as there is no acidosis.
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Focal neurological deficits are sometimes seen.
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They are prone to arterial and vascular thrombosis.
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Insulin administration should be at the same rate as in DKA.
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Question 3 of 10

3. Question

Which statement is false about the fluid deficit in HHS?

Rapid changes in osmolality may be harmful.
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Use 0.9% sodium chloride solution as the principal fluid to restore circulating volume and reverse dehydration.
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Measurement or calculation of osmolality should be undertaken every hour initially and the rate of fluid replacement adjusted to ensure a positive fluid balance sufficient to promote a gradual decline in osmolality.
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Fluid replacement should be administered over a longer period of time than in DKA.
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Rapid changes in osmolality may be useful.
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Question 4 of 10

4. Question

Which is not true regarding the management of HHS?

The administration of IV fluid immediately on arrival is the lifesaving event
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Fluid replacement should be 50% of the deficit over the first 12 hours
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Even if the K+ is >5.5 potassium replacement should be commenced
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The recommended insulin should be about 0.05 units/kg/hour at a fixed rate
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Fluid replacement is with 0.9% normal saline
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Question 5 of 10

5. Question

HHS is diagnosed by?

Arterial blood gas
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Clinical assessment and history only
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Clinical assessment and ABG
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Venous blood gas
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Clinical assessment, history and VBG
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Question 6 of 10

6. Question

Which of the following is true in HHS?

Complete correction of electrolyte abnormalities should be achieved with in 24 hrs.
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Most of the patients are elderly and with co-morbidities.
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Previous functional status is not of much importance.
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Rapid correction of fluid deficit should be undertaken.
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The underlying precipitant will not alter the outcome .
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Question 7 of 10

7. Question

All statements are false regarding insulin in HHS except:

Subcutaneous insulin can be started initially.
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IV insulin should be continued despite the patient starting to eat and drink until BM <10.
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Oral hypoglycaemic agents can be started once BM is < 10 mmol.
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IV insulin can be discontinued once the patient starts eating and drinking.
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IV insulin should be adjusted according to the blood glucose level.
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Question 8 of 10

8. Question

Which of the following is a common electrolyte abnormality in HHS?

Hypercalcemia
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Hyponatremia
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Hypophosphatemia
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Hypocalcaemia
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Question 9 of 10

9. Question

Regarding anticoagulation, which should be used in HHS?

IV heparin prophylactic dose
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PO Rivaroxaban 15mg BID
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S/C LMWH- Prophylactic dose
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S/C LMWH – Therapeutic dose
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IV Alteplase
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Question 10 of 10

10. Question

Goals of management in HHS include:

Normalising the osmolality
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Replacing fluid and electrolyte losses
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Normalising blood glucose
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Prevention of arterial or venous thrombosis
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All of the above
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6 Comments

stockdalen December 6, 2022 at 7:45 pm

Good review of an often poorly-understood/managed condition.

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Dr Syed Shahbaz Ahmer March 2, 2023 at 5:39 pm

Great learning session

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Mr Salim Kadhim Shubber (Group Leader) September 27, 2023 at 11:33 am

It has given me a good insight into this condition

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Dr Lucky Osakue Idemudia May 25, 2024 at 2:27 pm

well explained

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Dr Ramesh Kumar May 25, 2024 at 8:03 pm

Excellent learning session

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Dr Muhammad Hanif Mahamud March 16, 2026 at 9:18 pm

good revision and effective learning outcomes

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