HHS
Deep Dive
Deep Dive
At what serum osmolality does altered mental status typically occur in HHS?
> 320
the degree of mental status change correlates with the degree of hyperosmolality
What is the mortality rate of HHS compared to DKA?
HHS mortality is ~10x higher than DKA
DKA inpatient mortality is 0.2-1 %
HHS mortality ranges from 0.77% to as high as 41% in some cohorts
Why is aggressive fluid resuscitation MORE important than insulin in HHS?
Volume repletion alone can lower glucose by 75-100 mg/dL/hr through improved renal perfusion and glycosuria
Premature or excessive insulin in a profoundly dehydrated patient can cause cardiovascular collapse and rapid osmolality shifts
What is the typical patient profile for HHS?
Older adult (>60) with T2DM, multiple comorbidities, and often limited access to water → nursing home resident, cognitively impaired patients)
What is the target glucose decline rate in HHS and how fast should serum osmolality be corrected ?
50-75 mg/dL/hr and 3 mOsm/kg/hr
avoid faster drops to prevent osmotic complications
overly rapid correction risks osmotic demyelination and cerebral edema