Hyperosmolar hyperglycaemic state (HHS)

Questionnaire/history: Blood glucose greater than 30 mmol/L for several days? Disorientation, drowsiness and/or confusion? Polyuria and polydipsia? Nausea? Severe dehydration (sunken eyes and prolonged capillary refill time)? Shock (tachycardia, poor peripheral perfusion, lethargy, drowsiness, decreased level of consciousness, reduced urine output)? Precipitating factors (eg infection, physiological stress (eg trauma or surgery), inadequate or non-adherence with insulin treatment regimen or intentional insulin omission in order to lose weight (diabulimia), new onset of diabetes mellitus? Past medical history (eg hypothyroidism or pancreatitis)? Current medication (eg corticosteroids, diuretics, atypical antipsychotics, sympathomimetic drugs (eg salbutamol))? Drug allergies? Investigations: Ketonuria ≥ 2+ on standard urine strip? Ketonaemia ≥ 3 mmol/L? Note: Consider the possibility of DKA in all people with type 1 diabetes who are unwell; hyperglycaemia may not always be present. Management: Emergency admission for fluid resuscitation and IV insulin Reference(s): NICE CKS: When should I suspect a hyperglycaemic emergency?