HHS Definition - Edubirdie

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

75

Pages:

5
Author:

Mariam A. A.

HHS Definition Severe life-threatening medical emergency that is a complication of mostly T2DM characterised but severe hyperglycaemia, severe dehydration, high blood osmolarity, changes in metal state and without significant ketones Triggers Infection Most common MI Surgery Skipping medications Decreased insulin Insulin resistance Risk factors T2DM Elderly Dementia Renal dysfunction Steroids Beta blockers Inappropriate diuretic use Clinical features History Exam Cardiovascular Tachycardia Decreased skin turgor Sunken eyes Polyurea Dry mouth Polydipsia Resp Weight loss Tachypnoea Weakness CNS Slow onset Drowsy Progressive dehydration Delirium Coma Coma Focal or generalised seizures Visual changes Hemiparesis HHS vs DKA HHS DKA Slow development Faster development May be many days Within hours pH more than 7.30 pH less than 7.30 may have mild acidosis metabolic acidosis HCO3 more than 18 HCO3 less than 18 Osmolarity more than 320 Variable osmolarity Glucose more than 33 Glucose more than 11 Diagnostic criteria Serum glucose more than 33 Serum osmolarity more than 320 Profound dehydration Elevated U:Cr No ketoacidosis Investigations CBC U&E, urea and creatinine Electrolyte abnormalities Renal dysfunction – common E.g. hypokalaemia, hypomagnesaemia, hyponatremia or hypernatremia Ketone – serum and urine Little or no ketonuria Serum ketones normal ABG If metabolic acidosis present not normal Investigations for cause: CXR: chest infection ECG: MI CRP Urine Blood cultures Management ABCDE May need intubation if coma and not protecting airways Anti-emetics Correct dehydration Do not replace loss and excessively Should replace about 50% of estimated fluid loss within the first 12 hours and the reminder in the following in 12 to 36 hours Given before insulin Low dose Rapid glucose reduction risk of cerebral oedema Glucose levels should be decreased at a rate of 4 to 6 per hour Reasonable target is 10 to 15 Replace electrolytes Especially K+ Provide insulin Correct metabolic acidosis DVT prophylaxis Complications Severe dehydration Most common Coma Seizures Cerebral oedema Hypotension Hypovolemic shock DVT Renal failure rhabdomyolysis Pancreatitis Prognosis Mortality rate from 5% to 20%