emDocs - January 2, 2020 - Authors: De Andrande Pereira R; Waseem M; Godil M
Reviewed by: Lew E; Koyfman A; Long B
"Take Home Points
- HHS is a medical emergency and therefore early recognition and aggressive resuscitation with fluids are critical for survival. It is important that physicians have a high index of suspicion particularly with obese patients presenting with altered mental status and hyperglycemia. Beware that there can be overlap between DKA and HHS. Consequently, patients may present with features of both conditions.
- HHS is driven by osmotic diuresis with an overwhelming dehydration. Fluid replacement with Normal saline is an important initial step.
- Insulin is more effective following fluid replacement and decreases osmolality and plasma glucose continually.
- Monitor and replace electrolyte as necessary.
- Continuous monitoring of vital signs and mental status are important."