Last Modified: 3:18pm 15/04/2021
How to recognise HHS
Hyperosmolar Hyperglycaemic State (HHS) occurs in people with Type 2 diabetes who experience very high blood glucose levels (often over 40mmol/l). It can develop over a course of weeks through a combination of illness (e.g.infection) and dehydration.
Hyperosmolar hyperglycaemic state (HHS) has no precise definition, but characteristic features that differentiate it from other hyperglycaemic states such as Diabetic ketoacidosis (DKA) are
- Marked hyperglycaemia (30mmol/L or more) without significant hyperketonaemia (< 3mmol/L),
ketonuria (2+ or less) or acidosis (pH>7.3, bicarbonate> 15mmol/L).
- Osmolality usually 320mosmol/kg or more.
N.B. A mixed picture of HHS and DKA may occur. Metabolic acidosis may be present in patients who are critically unwell.
HHS symptoms can frequently include:
- dry skin
- disorientation and, in later stages, drowsiness and a gradual loss of consciousness.
Hospital treatment for HHS aims to treat the underlying cause and to gradually and safely:
- Normalise the osmolality
- Replace fluid and electrolyte losses
- Normalise blood glucose.
Other goals include prevention of:
- Arterial or venous thrombosis
- Other potential complications e.g. cerebral oedema/central pontine myelinolysis
- Foot ulceration
Resolution of HHS occurs when there is complete normalisation of electrolytes and osmolality, this may take up to 72 hours.