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● HHS (DM type 2-typical) and the more common DKA (DM type 1-typical) are life-threatening emergencies most frequently caused by therapy non-adherence or infections and characterized by hyperglycemia, glycosuria, severe dehydration, and acidosis. DKA is additionally accompanied by ketonemia and the pH and bicarbonate are lower (pH<7.2, HCO3<5 mmol/L) than in HHS, reflecting the totality of insulin loss.
● Treat in an ICU, immediately injecting heparin to prevent thrombosis. Correct the substantial (several liters!) fluid loss i.v. with isotonic solutions. The infusion rate (0.1-1.0 L/h) should ideally be guided by central venous pressure. Add potassium chloride under ECG monitoring unless hyperkalemia. Administer 10 mmol/h at potassium level of 4.5-6 mmol/L and 20 mmol/h at 3-4.5 mmol/L.
● Treat hyperglycemia with normal insulin i.v. Start with a bolus of 2-10 IU, depending on the initial glycemia. Follow by an infusion of 2-6 IU/h, adjusting to achieve a rate of glycemia decrease not exceeding 50 mg/dL/h. Reduce to 2-6 IU/h at glycemia of 250 mg/dL, to avoid hypoglycemic undershoot.
● Identify and treat the factor that triggered the emergency.
≣ HSS Slides 14 to 19
≣ DKA