Discuss the Pathogenesis, Presentation and Management of HHS

Abstract

Hyperosmolar hyperglycaemic state (HHS) classically happens in type 2 diabetes formerly recognised as hyperosmolar non-ketotic (HONK) state. The level of blood glucose can be greater than that is DKA (gt;50 mmol/litre) however there is no ketone in urine. It is accompanying with severe dehydration and patients necessitate importunate, directed fluid resuscitation, correction of electrolyte disturbances and insulin. The characteristic features of HHS a syndrome are severe hyperglycaemia, hyper osmolality and excessive water loss in the non-appearance of ketoacidosis. Occurrence of HHS among diabetic patients is approximately less than 1%. Higher percentage of cases occur in elder type 2 diabetic patients still, young adult and children are also prone to develop HHS. The mortality rate approximately 20% which is around 10 times DKA mortality rate. The dehydration severity, existence of comorbidities and old age determined the prognosis of HHS. The management of HHS is focussed on correction of volume deficit, hyper osmolality, hyperglycaemia, and electrolyte abnormalities in addition to treating the underlying causes which trigger the metabolic decompensation. Although regime of intravenous low dose insulin meant for mange DKA seem to be effectual, the better therapy approaches for the treatment of HHS have not established by any prospective randomized studies.