Clinical assessment and risk stratification

Precipitating factors of hyperosmolar hyperglycaemic state (HHS) include:

• Infection
• Inadequate insulin or non-adherence to diabetic treatment.
• New onset of diabetes mellitus or other physiological stress (such as trauma or surgery).
• Other medical conditions (such as hypothyroidism or pancreatitis).
• Drugs (such as corticosteroids, diuretics, atypical antipsychotics, and sympathomimetic drugs such as salbutamol).

Markers of Severity Indicating the Need for High Dependency / Level 2 Care:

Consider the need for admission to a high-dependency unit / level 2 environment, when one or more of the following are present:

• osmolality greater than 350 mosmol/kg
• sodium above 160 mEq/L
• venous ⁄ arterial pH below 7.1
• hypokalaemia (less than 3.5 mEq/L) or hyperkalaemia (greater than 6 mEq/L) on admission
• Glasgow Coma Scale (GCS) less than 12 or abnormal
• oxygen saturation below 92% on air (assuming normal baseline respiratory function)
• systolic blood pressure below 90 mmHg
• pulse over 100 or below 60 bpm
• urine output less than 0.5 ml/kg/hr
• serum creatinine >200 µmol/L
• hypothermia
• macrovascular event such as myocardial infarction or stroke
• other serious co-morbidity

Question