Hyperglycemic Hyperosmolar State (HHS)
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1. Diagnostic Criteria for HHS
- Serum Glucose: > 600 mg/dL
- Serum Osmolality: > 320 mOsm/kg
- pH > 7.3
- Bicarbonate > 15 mmol/L
- Minimal or no ketonemia/ketonuria
2. Initial Management of HHS
A. Fluid Resuscitation
- Initial Bolus: 0.9% NaCl, 10-20 mL/kg over 1-2 hours.
- Deficit Replacement: 0.45-0.75% NaCl, with the goal of correcting dehydration over 24-48 hours.
B. Insulin Therapy
- Begin when blood glucose reduction plateaus with fluids.
- Low-Dose Insulin Infusion: 0.025-0.05 units/kg/hour.
- Avoid bolus insulin to prevent rapid osmolar shifts.
C. Electrolyte Management
- Potassium Replacement: As for DKA, based on serum potassium levels.
- Phosphate Replacement: Only in cases of severe hypophosphatemia.
3. Monitoring and Complications
- Close monitoring of blood glucose and electrolytes.
- Watch for rhabdomyolysis or acute kidney injury.
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