Other electrolyte imbalances and complications associated with HHS

Hypophosphataemia and hypomagnesaemia are common in HHS. As with the management of DKA there is no evidence of benefit of treatment with phosphate infusion. However, these patients are often elderly and may be malnourished, and the re-feeding syndrome could be precipitated once the person begins to eat. If hypophosphataemia persists beyond the acute phase of treatment of HHS, oral or IV replacement should be considered. Magnesium replacement has also not been shown to be beneficial so should only be considered if the patient is symptomatic or has symptomatic hypocalcaemia.


Learning bites

  • Always start with ABCD assessment
  • An adequate history must be taken
  • Examination performed searching for the underlying cause that precipitated HSS