1. Diagnostic Criteria for HHS
Serum Glucose: > 600 mg/dL
Serum Osmolality: > 320 mOsm/kg
pH > 7.3
Bicarbonate > 15 mmol/L
Minimal or no ketonemia/ketonuria
2. Initial Management of HHS
A. Fluid Resuscitation
Initial Bolus: 0.9% NaCl, 10-20 mL/kg over 1-2 hours.
Deficit Replacement: 0.45-0.75% NaCl, with the goal of correcting dehydration over 24-48 hours.
B. Insulin Therapy
Begin when blood glucose reduction plateaus with fluids.
Low-Dose Insulin Infusion: 0.025-0.05 units/kg/hour.
Avoid bolus insulin to prevent rapid osmolar shifts.
C. Electrolyte Management
Potassium Replacement: As for DKA, based on serum potassium levels.
Phosphate Replacement: Only in cases of severe hypophosphatemia.
3. Monitoring and Complications
Close monitoring of blood glucose and electrolytes.
Watch for rhabdomyolysis or acute kidney injury.
Comments