HYPEROSMOLAR HYPERGLYCEMIC STATE

1. HYPEROSMOLAR
HYPERGLYCEMIC STATE
Presented by:-
ANTARA GHOSH
BATCH 12

2. What is DIABETES MELLITUS?
Diabetes Mellitus is a group of
metabolic diseases characterized by
high blood glucose level,
disturbances of carbohydrate, fat
and protein metabolism resulting
from defects in insulin secretion, or
action, or both.

3. HHS – An Acute Complication Of
Diabetes mallitus
Hyperosmolar hyperglycemic
state is a life-threatening
emergency manifested by
marked elevation of blood
glucose, hyperosmolarity, and
little or no ketosis.
The hallmark of hyperosmolar
hyperglycemic state is profound
dehydration, marked
hyperglycemia, and often some
degree of neurologic impairment
with mild or no ketosis.

4. Common Risk Factors
♦ Uncontrolled or
undiagnosed DM type II
♦Advanced age
♦Infection (Pneumonia,
UTI, Sepsis, Cellulitis)
♦Medications
♦ Vascular events such as
Cerebrovascular accident,
myocardial infarction
♦Alcohol abuse,
♦ Endocrinological disorders –
Acromegaly, Thyrotoxicosis
♦Comorbid illness such as Acute
Pancreatitis, Severe Burn Injury,
Substance Abuse (Alcohol Abuse
or Cocaine use) ,Renal
Insufficiency
♦ Insulin discontinuation or
reduction are precipitating factors
HHS.

5. Signs & Symptoms
• Symptoms related to
hyperglycemia
– Polyuria
– Polydipsia
– Weight loss
• Symptoms common at
presentation
– Weakness
– Visual changes
– Leg cramps
• Neurologic changes occur later
– Progressive Decreased Level of
Consciousness (coma)
– Seizures (5%)
Physical manifestations
• Poor skin turgor,
• Tachycardia,
• Hypotension,
• Change in mental status,
• Shock,
• Ultimately coma.

6. TREATMENT
RECOVERY
Sick Day
Rules
MONITORING
MANAGEMENT

7. Treatement:-
• Correction of dehydration
• Correction of hyperglycemia
• Correction of electrolytes imbalance
• Identification of precipitating events
• Frequent patient monitoring
contd…

8. Fluid replacement:-
• Fluid replacement is essential in initial
treatment to reverse dehydration serum
electrolytes & urine output
• Shock & severe dehydration must be
corrected with normal saline(0.9%).
contd…

9. Insulin:-
• To avoid ketogenesis and hyperglycemia
• Regular insulin at dose of 0.1u/kg/hr by continuous intravenous
infusion is treatment of choice
Potassium Replacement:-
• Potassium replacement should not be
started until serum plasma concentration is
<5.5mEq/l.
• If hyperkalemia:
– Correction of acidosis
– Volume replacement
– Insulin therapy
• If hypokalemia:
– 10~20 mEq/hr K+

10. Monitoring
Monitoring is required on
• Blood glucose
• Serum electrolyte
• Phophate
• Venous pH

11. Sick Days Management:-
When you are ill :
• Check your blood sugar every four hrs
• Test for ketones if your blood sugars are above
240mg/dl, or as directed by your health care
provider .
• Check your temperature regularly.
• Make sure you are drinking adequate liquids.
• Do not stop taking your insulin.
• Inform your reletives about your illness

12. Sick days management contd…
When Should I Call My Doctor?
• Your blood sugar stays higher than 180
mg/dL or lower than 70 mg/dL.
• You are unable to keep liquids or solids
down.
• You have a fever (temperature over 101
degrees F or 38.3 degrees C).
• You have diarrhea or are vomiting. Hospital

13. Prevention is better than cure
“Many Cases of DKA and HHS
can be prevented by better access
to medical care, proper education
and effective communication
with the health care provider
during the intercurrent illness”