HHS (A.K.A. HONK) is a diabetic emergency, but unlike DKA we don’t always think about it.

Patients with HHS are often elderly with multiple co-morbidities, and they are always very sick.

Definition

• Hypovolaemia
• Hyperglycaemia – generally ≥30mmol/l
• High Osmolality – generally ≥320mosmol/kg (Calculation= 2[Na] + [Glucose] + [Urea])
• & NOT:
  • Acidotic – pH >7.3, HCO3 >15mmol/l
  • Ketotic – blood <3mmol/l, Urine <2+

Treatment

Fluid

• Mainstay of treatment
• Target 2-3l in the first 6 hrs – Initial 1l NaCl 0.9% over 1hr, then 0.5-1l/hr
  • May need to be quicker if SBP <90mmHg
  • May need to be cautions in renal OR cardiac failure patients
• Glucose fall – >5mmol/l per hr

Insulin

• Only start if – Evidence of DKA, OR glucose falling by <5mmol/l per hr
• 0.05unit/kg/hr – consider increase to 0.1unit/kg/hr if glucose falling by <5mmol/l per hr
• Avoid hypoglycaemia – target 10-15mmol/l

Potassium

• [K] >5.5mmol/l – no added potassium
• [K] 3.5-5.5mmol/l – Start KCL 40mmol/l infusion (max 10mmol/hr)
• [K] <3.5mmol/l – Senior review

Throboprophylaxis

• Patients at high risk thrombosis
• Commence prophylactic LMWH – unless contraindicated

PDF: HSS guide