Management of Hyperglycaemic Hyperosmolar State (HHS)
The complex pathophysiology and management of HHS means that level 2 care is usually the most appropriate, with early input from specialist inpatient Diabetes Team via TrakCare.
Diagnosis criteria for HHS
- Laboratory glucose >30mmol/L
- Serum osmolality >320mosmol/kg [calculate serum osmolality: 2(Na+ + K+) + glucose + urea]
- Venous blood gas [H+] <50nmol/L
- Venous bicarbonate >15mmol/L
- Capillary blood ketones <3mmol/L (urine ketones <3+).
The NHSGGC guideline and care pathways on the management of HHS can be found here on the NHSGGC Clinical Guidelines Platform. It covers:
- Five headline concepts to consider:
- Correct diagnosis - differentiating between HHS and diabetic ketoacidosis
- Appropriate IV fluids to use
- Insulin - when to commence it and at what rate
- Treatment target ranges
- Other issues - electrolytes, anticoagulation, co-presenting illness, pressure ulcer risk.
- Care pathway 1: 0–6 hours of HHS management
- Care pathway 2: >6hours – resolution
- Appendix A - when to start fixed rate insulin.
Guideline reviewed: May 2023
Page updated: October 2023