(A&E)

Overview

• Characterised by profound hyperglycaemia (>30), hyperosmolality (>320), and volume depletion (dehydration) in the absence of significant ketoacidosis
• Most commonly occurs in older people with type 2 diabetes
• May be initial presentation of T2DM
• In HHS there are still small amounts of insulin being secreted by the pancreas, hence DKA is prevented
• Risk Factors → infection (most commonly pneumonia or UTI), surgery, inadequate insulin therapy, acute illness (MI, sepsis, stroke), non-adherence to diabetes medications

Making Diagnosis

Clinical Features:

• Acute Cognitive Impairment → may be recorded via GCS (due to hypernatraemia)
• Polyuria, Polydipsia, Weight Loss, N&V
• Dry Mucous Membranes & Decreased Skin Turgor → signs of volume depletion
• More insidious onset (over days)

(DKA DISTINGUISHING FEATURES → rapid onset, abdominal pain, fruity breath odour, kussmaul respirations)

Investigations: