IBCC Episode 94 - Hyperosmolar Hyperglycemic State

In this episode of The Internet Book of Critical Care Podcast, Josh and Adam discuss hyperosmolar hyperglycemic state (HHS), differentiating it from diabetic ketoacidosis (DKA). They explain the pathophysiology, focusing on the concepts of osmolality and tenacity, and the importance of avoiding rapid shifts in these parameters during resuscitation to prevent cerebral edema. The hosts detail the diagnostic criteria for HHS, emphasizing the significance of clinical presentation alongside lab values, and address the overlap between HHS and DKA. They also cover the evaluation process, including identifying precipitating factors and relevant lab tests. The discussion then shifts to treatment, advocating for a cautious, stepwise approach involving fluid resuscitation and insulin administration, with careful monitoring of electrolytes and serum osmolality or corrected sodium, and they stress the importance of slow correction, especially in younger patients, to avoid neurological complications, and they touch on the association of rhabdomyolysis with HHS.