Hyperosmolar Hyperglycemic State HHS The Johns Hopkins Patient Guide To Diabetes

hhs diabetes

Hence, in the treatment of HHS, the goal of treatment is a slow correction of hyperglycemia. The first test in HHS is a fingerstick to determine the serum glucose level. The higher the level of glucose, the greater the serum osmolarity and the higher the degree of dehydration. active The typical clinical presentation of patients with HHS is increased urination (polyuria) and increased water intake (polydipsia). This is a result of the stimulation of the thirst center in the brain from severe dehydration and increased serum osmolarity.

If you have HHS but haven’t already received a diabetes diagnosis, your doctor may perform a urinalysis to see if you have diabetes. Go to the emergency room or call 911 right away if you have symptoms of HHS. Medications should be reviewed to identify any that may precipitate or aggravate HHS; these medications should be discontinued or reduced. Investigation for other causes may be indicated after reviewing the precipitating factors6 (Table 225 ). There is a disproportionally high number of African Americans, Native Americans, and Hispanics who are afflicted with HHS.

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Consultations with an endocrinologist and an intensive care specialist are recommended. Appropriate resuscitation with attention to the principle of Airway, Breathing, Circulation (ABC) should be initiated. Patients with HHS can present with altered mental status as a result of significant fluid depletion and decreased cerebral perfusion.

hhs diabetes

Identification and treatment of underlying and precipitating causes are necessary. Insulin Insulin General treatment of diabetes mellitus for all patients involves lifestyle changes, including diet and exercise. Appropriate monitoring and control of blood glucose levels is essential to prevent… Read more is given at these details 0.1 unit/kg IV bolus followed by a 0.1 unit/kg/hour infusion after the first liter of saline has been infused and hypokalemia has been corrected. Hydration alone can sometimes precipitously decrease plasma glucose, so insulin dose may need to be reduced. A too-quick reduction in osmolality can lead to cerebral edema.

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At the start of treatment, the goal is to correct the water loss. This will improve the blood pressure, urine such a good point output, and circulation. Hyperglycemia can develop with diabetic ketoacidosis and diabetes insipidus.

Often, people develop HHS following an infection or cardiac event. Of all HHS cases, 90 95% occur in people with type 2 diabetes. Dextrose should be added once the glucose level reaches 250 to 300 mg/dL (13.9 to 16.7 mmol/L).

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