Endo: Hyperosmolar Hyperglycaemic State: Free MSRA Podcast

🎧 FREE MSRA PODCAST – Hyperosmolar Hyperglycaemic State (HHS): High Sugar, High StakesIn this essential MSRA episode, we break down everything you need to know about HHS, a dangerous complication of Type 2 Diabetes. Learn to identify it early, treat it effectively, and remember the critical differences from DKA.🧠 Key Learning Points📌 Definition• A diabetic emergency defined by: – Severe hyperglycaemia (>30 mmol/L) – High serum osmolality (>320 mOsm/kg) – No significant ketones or acidosis (pH >7.3, bicarb >15)• Develops gradually and seen mostly in older adults with T2DM📌 Causes & Triggers• Infection (e.g., UTI, pneumonia)• Poor diabetes control or new diagnosis• Medications: steroids, diuretics, beta-blockers, antipsychotics• Acute illness: MI, CVA, pancreatitis, PE, AKI• Other: dehydration, heatwaves, dementia, alcohol, drugs📌 Pathophysiology• Relative insulin deficiency → hyperglycaemia• Osmotic diuresis → profound dehydration and electrolyte loss• High serum glucose pulls water from cells → cellular dehydration• Brain particularly affected → altered mental state, coma📌 Symptoms & Signs• Polyuria, polydipsia, weakness• Confusion, drowsiness, seizures, coma• Signs of dehydration: dry mouth, poor skin turgor, hypotension• Neurological: focal deficits, visual disturbance• Labs: very high glucose, normal or mildly raised ketones, pH >7.3📌 Differentials• DKA – but HHS = minimal ketones, no acidosis• Sepsis, stroke, drug-induced hyperglycaemia• Pancreatitis, thyroid storm📌 Diagnosis• Blood glucose >30 mmol/L• Serum osmolality >320 mOsm/kg• ABG: no significant acidosis• Electrolytes: monitor Na⁺, K⁺, urea, creatinine• Rule out infection and other triggers• Calculate osmolality: 2(Na⁺ + K⁺) + glucose + urea📌 ManagementFluids first – IV 0.9% saline • Restore circulation slowly to prevent cerebral oedemaElectrolyte correction – watch for hypo/hyperkalaemiaInsulin – start only after fluids, low-dose fixed rateTreat underlying cause – infection, MI, stroke etc.Thromboprophylaxis – LMWH due to VTE riskMonitor: glucose, osmolality, neuro status, fluid balance📌 Complications• High mortality (10–20%)• Cerebral oedema, osmotic demyelination• DVT/PE, arrhythmias, renal failure• Long-term risk of recurrence if not addressed📎 More MSRA Resources for Hyperosmolar Hyperglycaemic State📝 Revision Notes:https://www.passthemsra.com/topic/hyperosmolar-hyperglycaemic-state-revision-notes/🧠 Flashcards:https://www.passthemsra.com/topic/hyperosmolar-hyperglycaemic-state-flashcards/💬 Accordion Q&A Notes:https://www.passthemsra.com/topic/hyperosmolar-hyperglycaemic-state-accordion-qa-notes/🚀 Rapid Quiz:https://www.passthemsra.com/topic/hyperosmolar-hyperglycaemic-state-rapid-quiz/🎓 Full Course:https://www.passthemsra.com/courses/endocrinology-for-the-msra/#MSRA #MSRARevision #HHSMSRA #Hyperglycaemia #MSRAFlashcards #DKAvsHHS #EndocrinologyMSRA #PassTheMSRA #MedicalEducation #DiabetesEmergency #MSRAOnlineRevision