Hyperosmolar hyperglycemic state

Revision as of 23:58, 27 September 2011 by Jswartz (talk | contribs)

Background

Pathophysiology

  1. Occurs due to 3 factors:
    1. Insulin resistance or deficiency
    2. Increased hepatic gluconeogenesis and glycogenolysis
    3. Osmotic diuresis and dehydration followed by impaired renal excretion of glucose
      1. May result in TBW losses of 8-12L
  2. Ketosis usually absent (may be mild)
  3. Prototypical pt is elderly pt w/ uncontrolled type II DM without adequate access to H2O

Precipitants

  1. PNA
  2. UTI
  3. Medication non-compliance
  4. Cocaine use
  5. Meds: Beta-blockers, diuretics
  6. GI hemorrhage
  7. Pancreatitis
  8. Heat-related illness
  9. ACS
  10. CVA

Clinical Features

  • Dehydration
    • Hypotension
  • Seizure (15% of pts)
  • ALOC
  • Lethargy/coma

Diagnosis

  • Glucose >600
  • Osm >315
  • Bicarb >15
  • pH >7.3
  • Serum ketones negative or mildly positive

Work Up

  1. Chem
    1. Hypokalemia must be aggressively treated
  2. Osm
  3. Lactate
  4. Serum ketones
  5. CBC
  6. Also consider:
    1. Blood cx
    2. UA/UCx
    3. LFTs
    4. Lipase
    5. Troponin
    6. CXR
    7. ECG
    8. Head CT

Treatment

HHS.jpg


See Also

Source

Tintinalli's