4 Problem (Emergency Medicine)

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Yenny Darmawan
405180099
Group 9
Hyperosmolar Hyperglycemia
 Hyperosmolar
Hyperglycemic State (HHS)
• Is a life-threatening emergency that most
commonly affects adults with type 2
diabetes mellitus (who can still produce
insulin)

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 Clinical Presentation
Physical findings Laboratory findings
• Dehydration: • Plasma glucose level (> 600 mg per dL or
• Poor tissue turgor
• Dry buccal mucosa
33.3 mmol per L)
• Sunken eyeballs • Effective serum osmolality (> 320 mOsm per
• Cool extremities kg)
• Rapid, thready pulse
• Coma often occurs once the serum osmolarity is • Arterial pH level > 7.30
>340 mOsm per kg • Little or no urine / serum ketones
• Seizures occur in up to 25% of patients and may be • Serum bicarbonate level (> 15 mEq per L)
generalized, focal, myoclonic jerking, or movement
induced • One-half of patients will have a mild anion-
• Hemiparesis (resolve when the fluid deficit is gap metabolic acidosis (i.e., 10 to 12)
corrected) • Serum potassium levels may be ↑/N
• Adult  low-grade fever
• Creatinine, blood urea nitrogen, and
• Children  nonspecific symptoms (headache,
weakness, vomiting with or without abdominal pain) hematocrit levels are almost always ↑
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 Treatment

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 Identify and treat the cause
• Routine antibiotics are not recommended for all patients with
suspected infection  warranted while awaiting culture results in
older patients or in those with hypotension
• An elevated C-reactive protein level is an early indicator of sepsis in
patients with HHS
• Medications should be reviewed to identify any that may precipitate
or aggravate HHS  should be discontinued or reduced.
• Investigation for other causes may be indicated after reviewing the
precipitating factor

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 Complications Prognosis
• Vascular occlusion • Mortality rate  10-50% (higher
• Mesenteric artery thrombosis that of DKA)
• Myocardial infarction • Mortality rate in children  60%
• Disseminated intravascular
coagulopathy
• Cerebrovascular accident
• Bilateral femoral artery thrombosis
• Rhabdomyolysis  acute renal failure
• Children  malignant hyperthermia-
like syndrome (high fever >40°C),
elevated creatine kinase level

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