DIABETES MELLITUS-HHNK

SUMMARY

HYPERGLYCEMIC HYPEROSMOLAR STATE
1. This hyperglycemic complication happens in T2DM and is caused by partial insulin deficiency and dehydration.

2. The patient is usually elderly.

3. Exam is consistent with severe dehydration and volume depletion. These patients are not acidotic, so they do not have the fruity breath or Kussmaul respirations.

4. Inx: hyperglycemia and evidence of dehydration/volume depletion (Na⁺ deficit-noted after correction for the hyperglycemia) and azotemia.

5. Treat HHNK similarly to DKA, with IV fluid resuscitation and insulin bolus +/- infusion.

6. Be sure to adjust the serum sodium for the hyperglycemia to determine if a free water deficit exists, then replace it gradually over the next 24-48 hours. Potassium replacement is usually required.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].