Diabetes Complications: Hyperosmolar Hyperglycemic State (HHS)

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Questions and Answers

What is the typical serum glucose level in DKA?

Greater than 300 mg/dL (correct)

Greater than 600 mg/dL

Less than 100 mg/dL

Less than 200 mg/dL

Which type of diabetic is HHS more common in?

Type 1 diabetics

Neither type 1 nor type 2 diabetics

Both type 1 and type 2 diabetics

Type 2 diabetics (correct)

What is the initial rate of normal saline often used to correct dehydration in HHS?

1 L/h (correct)

0.5 L/h

5 L/h

2 L/h

What is the primary goal of insulin infusion in HHS treatment?

To reduce blood glucose concentration Signup and view all the answers

Why is potassium replacement required in HHS treatment?

Because metabolic problems are being corrected Signup and view all the answers

What is the minimum serum potassium level required before starting insulin infusion?

3.3 mEq/L Signup and view all the answers

What is the typical duration for correcting dehydration in HHS?

24 hours Signup and view all the answers

What is the target blood glucose level in HHS treatment?

Less than 200 mg/dL Signup and view all the answers

What is the primary risk factor for developing Hyperosmolar Hyperglycemic State (HHS)?

History of diabetes mellitus type 2 Signup and view all the answers

What is the typical plasma glucose level in Hyperosmolar Hyperglycemic State (HHS)?

>30 mmol/L (>600 mg/dL) Signup and view all the answers

Which of the following is a distinguishing feature of Hyperosmolar Hyperglycemic State (HHS) compared to Diabetic Ketoacidosis (DKA)?

Absence of significant ketoacidosis Signup and view all the answers

What is the typical serum osmolality in Hyperosmolar Hyperglycemic State (HHS)?

>320 mOsm/kg Signup and view all the answers

Which of the following medications is a potential trigger for Hyperosmolar Hyperglycemic State (HHS)?

Glucocorticoids Signup and view all the answers

What is the typical level of ketonuria in Hyperosmolar Hyperglycemic State (HHS)?

~+ on dipstick Signup and view all the answers

What is the typical MRI finding in Hyperosmolar Hyperglycemic State (HHS)?

Cortical restricted diffusion with reversible T2 hypointensity Signup and view all the answers

What is the typical level of creatinine in Hyperosmolar Hyperglycemic State (HHS)?

>1.5 mg/dL Signup and view all the answers

Study Notes

Hyperosmolar Hyperglycemic State (HHS)

Definition: A complication of diabetes mellitus, characterized by high blood sugar, high osmolarity, and no significant ketoacidosis.
Also known as Hyperosmolar Non-Ketotic State (HONK).

Signs and Symptoms

Altered level of consciousness
Neurologic signs: blurred vision, headaches, focal seizures, myoclonic jerking, reversible paralysis
Motor abnormalities: flaccidity, depressed reflexes, tremors, or fasciculations
Hyperviscosity and increased risk of blood clot formation
Dehydration
Weight loss
Nausea, vomiting, and abdominal pain
Weakness
Low blood pressure with standing

Causes and Risk Factors

Main risk factor: history of diabetes mellitus type 2
Other risk factors: infections, stroke, trauma, certain medications, heart attacks, lack of sufficient insulin, poor kidney function, poor fluid intake, older age (50-70 years), certain medical conditions, and certain medications

Diagnosis

Plasma glucose level >30 mmol/L (>600 mg/dL)
Serum osmolality >320 mOsm/kg
Profound dehydration, up to an average of 9L
Serum pH >7.30
Bicarbonate >15 mEq/L
Small ketonuria (~+ on dipstick) and absent-to-low ketonemia (<30 mg/dL)
Creatinine >1.5 mg/dL (increased)
MRI may show cortical restricted diffusion with reversible T2 hypointensity in the subcortical white matter

Differential Diagnosis

Main differential diagnosis: diabetic ketoacidosis (DKA)
Distinctions from DKA: serum glucose levels, type of diabetes, rapid onset vs. gradual onset, ketosis vs. no ketosis

Management

Reestablishing tissue perfusion using intravenous fluids
Initial treatment: correction of dehydration over 24 hours with normal saline at a rate of 1 L/h for the first few hours
Electrolyte replacement: potassium replacement at a rate of 10 mEq per hour, as long as there is adequate urinary output
Insulin administration: to reduce blood glucose concentration, with careful monitoring of potassium levels to avoid hypokalemia

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Description

This quiz covers the symptoms, signs, and complications of Hyperosmolar Hyperglycemic State (HHS), a serious condition that occurs in people with diabetes. Learn about the effects of high blood sugar on the body.