Main principles of HHS management
- Measure or calculate osmolality (2Na+ + glucose + urea) frequently to monitor the response to treatment.
- Use IV 0.9% sodium chloride solution as the principal fluid to restore circulating volume and reverse dehydration. …
- The fall in blood glucose should be no more than 5 mmol/L/hour.
Regarding this, are you Acidotic in HHS?
A wide anion gap can be observed in patients with HHS, reflecting mild metabolic acidosis. The mild acidosis in HHS is often multifactorial and results, in part, from the accumulation of minimal ketoacids in the absence of effective insulin activity.
People also ask, can HHS cause seizures?
In more advanced HHS, presentation is more likely to be altered mental status, seizures and/or coma. Patients may also present with an underlying fever, a clue to an underlying infection.
Can Type 2 diabetics get HHS?
Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of type 2 diabetes. It involves extremely high blood sugar (glucose) level without the presence of ketones.
Does HHS cause hyponatremia?
Hyperglycemia may cause dilutional hyponatremia, so measured serum sodium is corrected by adding 1.6 mEq/L (1.6 mmol/L) for each 100 mg/dL (5.6 mmol/L) elevation of serum glucose over 100 mg/dL (5.6 mmol/L). BUN and serum creatinine levels are markedly increased.
Does HHS need insulin drip?
indications: who needs an insulin infusion? Not every patient with HHS necessarily requires an insulin infusion. In many patients, volume resuscitation plus subcutaneous insulin will be perfectly adequate to achieve glycemic control.
How much fluid do you give in HHS?
According to American Diabetes Association guidelines, fluid resuscitation with 0.9% saline at the rate of 15-20 mL/kg/h or greater is indicated to expand the extracellular volume quickly in the first hour. This amounts to about 1-1.5 L in an average-sized person.
How much insulin do you need for HHS?
In adults, insulin should be started with an initial intravenous bolus of 0.1 units per kg, followed by a continuous infusion of 0.1 units per kg per hour until the blood glucose level falls to 250 to 300 mg per dL (13.9 to 16.7 mmol per L).
What is anion gap in diabetic ketoacidosis?
Anion Gap. In patients with diabetic ketoacidosis, the anion gap is elevated ([Na + K] – [Cl + HCO3] greater than 10 mEq/L in mild cases and greater than 12 mEq/L in moderate and severe cases).
What is the sliding scale for insulin?
A sliding scale varies the dose of insulin based on blood glucose level. The higher your blood glucose the more insulin you take. The Sliding Scale method is more precise than fixed dose insulin in that it takes account of the fact that people’s blood glucose is not always in the normal range before meals.
Why is there no insulin in HHS?
Although many patients with HHS respond to fluids alone, IV insulin in dosages similar to those used in DKA can facilitate correction of hyperglycemia. Insulin used without concomitant vigorous fluid replacement increases the risk of shock.