Endocrine

Hyperosmolar Hyperglycaemic State

Reading Time:

Pathology

Hyperosmolar hyperglycaemia with dehydration and haemoconcentration. Counter-regulatory hormone excess with relative insulin deficit (able to switch off ketogenesis but not to control hyperglycaemia)

Aetiology

Elderly with intercurrent infections, intake of drinks with high sugar content, myocardial infarction, drugs (e.g. steroids, thiazide diuretics), non-compliance with diabetes medications, first presentation of type 2 diabetes

Signs

Dehydration, confusion, coma, polyuria, slurred speech, seizures and signs of stroke.

Symptoms

Lethargy, confusion, altered consciousness, neurological symptoms

Investigations

Bloods: Glucose (>40 mmol/l), serum electrolytes, serum osmolality 
>350mosmol/kg), ketones, septic screen
Venous Blood Gas: pH and bicarbonate
ECG: Rule out ischaemia or infarction
MSU: Screen for infection
Chest X-Ray: Screen for infection

Treatment

IV Fluids: 8-10 litre deficit to be corrected slowly as risk of cerebral oedema
Insulin: 3-5 units/hr to reduce glucose ~ 5mmol/L/hr. Monitor potassium.
VTE prophylaxis: Hypercoagulable state

Prognosis

Mortality up to 50% especially in elderly
Venous thromboembolism, permanent neurological sequelae 

Key Facts

Lorem ipsum dolor sit amet, sapien platea morbi dolor lacus nunc, nunc ullamcorper. Felis aliquet egestas vitae, nibh ante quis quis dolor sed mauris.

Key Images

Lorem ipsum dolor sit amet, sapien platea morbi dolor lacus nunc, nunc ullamcorper. Felis aliquet egestas vitae, nibh ante quis quis dolor sed mauris.

Key References

Lorem ipsum dolor sit amet, sapien platea morbi dolor lacus nunc, nunc ullamcorper. Felis aliquet egestas vitae, nibh ante quis quis dolor sed mauris.