Hyperosmolar Hyperglycaemic State

Pathophysiology

Clinical assessment and risk stratification

7 Topics

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

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

3. Question
Which statement is false about the fluid deficit in HHS?
- Rapid changes in osmolality may be harmful.
- Use 0.9% sodium chloride solution as the principal fluid to restore circulating volume and reverse dehydration.
- 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.
- Fluid replacement should be administered over a longer period of time than in DKA.
- Rapid changes in osmolality may be useful.
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
- Fluid replacement should be 50% of the deficit over the first 12 hours
- Even if the K+ is >5.5 potassium replacement should be commenced
- The recommended insulin should be about 0.05 units/kg/hour at a fixed rate
- Fluid replacement is with 0.9% normal saline
Question 5 of 10

5. Question
HHS is diagnosed by?
- Arterial blood gas
- Clinical assessment and history only
- Clinical assessment and ABG
- Venous blood gas
- Clinical assessment, history and VBG
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.
- Most of the patients are elderly and with co-morbidities.
- Previous functional status is not of much importance.
- Rapid correction of fluid deficit should be undertaken.
- The underlying precipitant will not alter the outcome .
Question 7 of 10

7. Question
All statements are false regarding insulin in HHS except:
- Subcutaneous insulin can be started initially.
- IV insulin should be continued despite the patient starting to eat and drink until BM <10.
- Oral hypoglycaemic agents can be started once BM is < 10 mmol.
- IV insulin can be discontinued once the patient starts eating and drinking.
- IV insulin should be adjusted according to the blood glucose level.
Question 8 of 10

8. Question
Which of the following is a common electrolyte abnormality in HHS?
- Hypercalcemia
- Hyponatremia
- Hypophosphatemia
- Hypocalcaemia
Question 9 of 10

9. Question
Regarding anticoagulation, which should be used in HHS?
- IV heparin prophylactic dose
- PO Rivaroxaban 15mg BID
- S/C LMWH- Prophylactic dose
- S/C LMWH – Therapeutic dose
- IV Alteplase
Question 10 of 10

10. Question
Goals of management in HHS include:
- Normalising the osmolality
- Replacing fluid and electrolyte losses
- Normalising blood glucose
- Prevention of arterial or venous thrombosis
- All of the above

5 Comments

Collapse 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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