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DKA isn't the only hyperglycemic emergency in peds patients.
Check out this peer review https://tinyurl.com/y5ldx5bh & follow this thread exploring the patho, clinical recognition, & mgmt of #HHS
#EmoryACPNP2020 @brownam130
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Check out this peer review https://tinyurl.com/y5ldx5bh & follow this thread exploring the patho, clinical recognition, & mgmt of #HHS
#EmoryACPNP2020 @brownam130
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#HHS or Hyperglycemic Hyperosmolar State usually affects adults with #T2DM
-Growing incidence in peds population d/t increased rates of childhood obesity
-Mixed features of #HHS and #DKA can also occur in #T1DM
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-Growing incidence in peds population d/t increased rates of childhood obesity
-Mixed features of #HHS and #DKA can also occur in #T1DM
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#HHS is characterized by 
serum glucose, serum osmolality, & hypertonic dehydration WITHOUT ketosis
Check out this quick overview of the patho of HHS
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serum glucose, serum osmolality, & hypertonic dehydration WITHOUT ketosisCheck out this quick overview of the patho of HHS
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Guideline criteria from @ispad_org for HHS:
-BG>600, arterial pH >7.30, bicarb >15
-Serum osmolality >320
- 0-minimal ketonuria & ketonemia
-And altered mental status
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-BG>600, arterial pH >7.30, bicarb >15
-Serum osmolality >320
- 0-minimal ketonuria & ketonemia
-And altered mental status
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Clinical Presentation similar to #DKA
-polyuria, polydipsia, abd pain, N/V, dehydration, & AMS
So why is #HHS so serious?
Dehydration progresses over days-week w/ few clinical signs. Hypertonicity preserves intravascular space despite extreme fluid & electrolyte losses
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-polyuria, polydipsia, abd pain, N/V, dehydration, & AMS
So why is #HHS so serious?
Dehydration progresses over days-week w/ few clinical signs. Hypertonicity preserves intravascular space despite extreme fluid & electrolyte losses
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Fluid losses in #HHS are DOUBLE 
that in #DKA. Cornerstones of mgmt include:
-Aggressive fluid resuscitation
-Electrolyte correction
-Maintaining renal perfusion
-Conservative insulin administration
Lets talk specifics!
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that in #DKA. Cornerstones of mgmt include:-Aggressive fluid resuscitation
-Electrolyte correction
-Maintaining renal perfusion
-Conservative insulin administration
Lets talk specifics!
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Fluid Resuscitation:
-20ml/kg of NS repeated to restore perfusion followed by
-0.45-0.75% NS over the next 24-48hrs for 12-15% of body weight
-slow Na correction at 0.5mmol/L/hr
-& replacement fluids of urinary losses
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-20ml/kg of NS repeated to restore perfusion followed by
-0.45-0.75% NS over the next 24-48hrs for 12-15% of body weight
-slow Na correction at 0.5mmol/L/hr
-& replacement fluids of urinary losses
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Early insulin therapy NOT recommended. Fluids alone=marked decrease in BG
-Initiate insulin @ 0.025-0.05 U/kg/hr once glucose is no longer declining @ > 50mg/hr with fluids alone
-Monitor glucose hourly
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-Initiate insulin @ 0.025-0.05 U/kg/hr once glucose is no longer declining @ > 50mg/hr with fluids alone
-Monitor glucose hourly
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Profound K, Mg, & phos depletion in #HHS
-Add K to IVF prior to insulin initiation when serum K < 5.5
-may consider mag and phosphate repletion as well
-Bicarb is contraindicated
d/t risk for hypokalemia
-Check serum electrolytes Q2-3h
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-Add K to IVF prior to insulin initiation when serum K < 5.5
-may consider mag and phosphate repletion as well
-Bicarb is contraindicated
d/t risk for hypokalemia -Check serum electrolytes Q2-3h
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