Management of hyperosmolar hyperglycaemic state in adults with diabetes

Area of Science:

• Endocrinology
• Metabolic Disorders
• Diabetes Management

Background:

• Hyperglycaemic hyperosmolar state (HHS) is a critical medical emergency with higher mortality than diabetic ketoacidosis (DKA).
• HHS develops gradually over days, leading to more extreme dehydration and metabolic disturbances compared to DKA's rapid onset.
• Potential complications of HHS include myocardial infarction, stroke, seizures, cerebral edema, and central pontine myelinolysis, with rapid osmolality changes potentially precipitating the latter.

Purpose of the Study:

• To summarize recent guidance on the management of Hyperglycaemic hyperosmolar state (HHS) in adults.
• To highlight key differences in approach between HHS and diabetic ketoacidosis (DKA).
• To provide evidence-based recommendations for monitoring and treatment of HHS.

Main Methods:

• Review and summarization of Joint British Diabetes Societies for Inpatient Care guidance on HHS.
• Analysis of key treatment principles including monitoring, fluid and insulin administration, and care delivery.
• Emphasis on differentiating HHS management from DKA protocols.

Main Results:

• Regular serum osmolality monitoring is crucial, aiming for a reduction of 3-8 mOsm/kg/h.
• Intravenous 0.9% sodium chloride is the primary fluid for resuscitation; insulin should be withheld until blood glucose naturally falls with fluids (unless ketonaemia is present).
• Early involvement of a diabetes specialist team and experienced nursing staff is recommended for optimal patient outcomes.

Conclusions:

• HHS management necessitates a distinct strategy from DKA, focusing on gradual correction of dehydration and metabolic abnormalities.
• Careful monitoring of serum osmolality and judicious use of fluids and insulin are paramount to avoid complications.
• Multidisciplinary team involvement and specialized care settings improve the management and prognosis of HHS patients.