Last Modified: 1:49pm 16/04/2021

Goals of treatment and new principles

Goals of treatment

The goals of treatment of HHS are 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.

New principles
• Measure or calculate osmolality (2Na+ + glucose + urea) frequently to monitor treatment
response.

• Use IV 0.9% sodium chloride solution as the principle fluid to restore circulating volume and
reverse dehydration. Only switch to 0.45% sodium chloride solution if the osmolality is not
declining despite adequate positive fluid balance.

• An initial rise in sodium is expected and is not in itself an indication for hypotonic fluids.
Thereafter, the rate of fall of plasma sodium should not exceed 10 mmol/L in 24 hours.

• The fall in blood glucose should be no more than 5 mmol/L/hr. Low dose IV insulin (0.05
units/kg/hr) should be commenced once the blood glucose is no longer falling with IV fluids
alone OR immediately if there is significant ketonaemia (3β-hydroxy butyrate greater than 1
mmol/L).

• Assess foot risk score on admission.

JBDS Guidance