Hyperosmolar Hyperglycaemic Syndrome (HHS)
Definition
Hyperglycaemia + hyperosmolality + dehydration (NO ketoacidosis)
Aetiology
Physiological stress (infection, IHD, surg, renal failure trauma)
Drugs (CS, diuretics)
Pathogenesis
Insufficient insulin --> cells unable to uptake glucose --> need glucose --> liver gluconeogenesis from amino acids (no lipolysis as some insulin present) --> hyperglycaemia --> renal leak --> dec vol --> renal hypoperfusion --> renal insufficiency --> hyperosmolality
Clinical Features
Investigations/ Management
Same as DKA (except that insulin is used to treat hyperglycaemia, not acidosis)
Source
Toronto Notes 2012
Hyperglycaemia + hyperosmolality + dehydration (NO ketoacidosis)
Aetiology
Physiological stress (infection, IHD, surg, renal failure trauma)
Drugs (CS, diuretics)
Pathogenesis
Insufficient insulin --> cells unable to uptake glucose --> need glucose --> liver gluconeogenesis from amino acids (no lipolysis as some insulin present) --> hyperglycaemia --> renal leak --> dec vol --> renal hypoperfusion --> renal insufficiency --> hyperosmolality
Clinical Features
- Insidious onset
- Polyuria/dipsia, dehydration
- Lethargy, confusion, coma (due inc osmolality)
Investigations/ Management
Same as DKA (except that insulin is used to treat hyperglycaemia, not acidosis)
Source
Toronto Notes 2012