{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":90,"width":600,"title":"HHS (Hyperosmolar Hyperglycaemic State)","description":"HHS (Hyperosmolar Hyperglycaemic State) is the quiet counterpart to DKA. It develops slowly in older type 2 diabetics with residual insulin, leading to extreme hyperglycaemia and dehydration without ketosis. In this 2-hour deep dive, Jonathan explains why HHS kills through water loss and hyperviscosity rather than acid, and how to manage it safely. Key Learning Points: \u00b7         Pathophysiology: Relative insulin deficiency \u2192 no ketones, but relentless osmotic diuresis \u2192 hyperosmolarity > 320 mOsm\/kg. \u00b7         Recognition: Elderly, confused, profoundly dehydrated, glucose often > 30 mmol\/L, Na\u207a high, pH > 7.3. \u00b7         Fluids first: Replace ~\u00bd deficit in 12 h with 0.9 % saline; adjust for heart\/kidney function. \u00b7         Insulin later: 0.05 u\/kg\/hr once osmolality is falling; aim glucose fall 3\u20136 mmol\/L\/hr. \u00b7         Add dextrose when glucose \u2248 14 mmol\/L to avoid cerebral oedema. \u00b7         Potassium vigilance: Replace according to level; withhold insulin if < 3.5 mmol\/L. \u00b7         Thromboprophylaxis essential. \u00b7         Monitoring: Hourly glucose & neuro obs, 2\u20134-hourly U&Es\/osmolality, strict fluid balance. \u00b7         Complications: Cerebral oedema, VTE, renal injury, electrolyte shifts, rhabdomyolysis. \u00b7         Take-home: In HHS, correct the water slowly, the sugar gently, and never forget the brain. ","author_name":"The Critical Care Practitioner","author_url":"http:\/\/criticalcarepractitioner.libsyn.com\/website","html":"