Hyperglycemic Emergencies Round 3

HHS Deep Dive

100

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

200

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 

300

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  

400

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) 

500

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