HHS
What does HHS stand for?
Hyperosmolar hyperglycaemic state
Which type of diabetes is mostly associated with DKA?
T2DM
Which organ primarily controls bicarbonate?
Kidneys.
pulse check
What breath sound is most commonly heard in asthma?
Wheeze.
What is generally the first major treatment priority for a patient with DKA or HHS?
Intravenous fluid replacement.
What type of breathing pattern is commonly seen in severe DKA?
Kussmaul respirations
A patient has a pH of 7.25 and HCO₃⁻ of 14 mmol/L. What acid-base disorder is present?
Metabolic acidosis.
Which cardiac rhythm requires immediate defibrillation?
Ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT).
What is the first-line medication for an actively seizing patient?
A benzodiazepine (e.g. midazolam)
Name three common neurological symptoms seen in HHS.
Confusion, lethargy, seizures, focal neurological deficits, reduced GCS or coma.
Why can potassium initially appear normal or elevated in DKA despite total body potassium depletion?
Acidosis and insulin deficiency cause potassium to shift out of the cells and into the bloodstream
What is the body's slowest mechanism for correcting acid-base imbalance?
Renal (kidney) compensation.
Which electrolyte abnormality commonly causes tall, peaked T waves?
Hyperkalaemia.
Which electrolyte imbalance commonly causes muscle weakness and cardiac arrhythmias?
Hypokalaemia.
Why don't most patients with HHS develop ketoacidosis?
hey usually produce enough insulin to suppress fat breakdown and ketone formation.
A patient with Type 1 diabetes presents in DKA after three days of vomiting and gastroenteritis. What is the most likely reason they developed DKA?
They likely stopped taking insulin because they weren't eating, but insulin is still required during illness ("sick day" management).
Which acid-base disorder is commonly seen in severe COPD exacerbations?
Respiratory acidosis.
What is Torsades de pointes? Do we shock it? How do we treat it?
> A rare, life-threatening form of ventricular tachycardia
> Yes, if unconscious... will usually go into VT through
> Mag! ALS
A patient suddenly becomes short of breath with PLEURITIC chest pain and tachycardia. What life-threatening condition should be considered first?
PE
Why is the mortality rate higher in HHS than in DKA?
Patients are generally older, have more comorbidities and present with more severe dehydration.
Why shouldn't the insulin infusion be stopped once the blood glucose reaches 12–14 mmol/L?
The ketoacidosis has often not resolved; insulin is still needed to stop ketone production, with dextrose added to prevent hypoglycaemia.
You pull a VBG and it shows that ... the pH is normal, pCO₂ is high and HCO₃⁻ is high. But the pt. has a hx of COPD. What are they in?
Fully compensated chronic respiratory acidosis.
What are the two drugs you would give during ALS?
Adrenaline + Amiodarone
An 80-year-old with Type 2 diabetes presents with confusion, profound dehydration, BGL 52 mmol/L, normal pH and minimal ketones. What is the most likely diagnosis?
HHS.