Master Hyperosmolar Hyperglycemic State with Picmonic for Medicine

In HHS, insulin is present which prevents lipolysis and ketogenesis. Lipolysis is the breakdown of fat which produces acid as a byproduct. Ketogenesis is the breakdown of fatty acids which produces ketones as a byproduct.

Serum osmolality is increased due to hyperglycemia induced polyuria leading to a state of severe dehydration. This state of severe dehydration leads to the symptoms of HHS.

Patients with hyperosmolar hyperglycemic state may have glucose levels of 600mg/dl or more. This severe glucose level leads to glucose toxicity and has a large osmotic effect. Patients have pronounced glucosuria as well, which leads to polyuria.

Lipolysis and ketogenesis does not occur in HHS, so acidosis and ketones are not present.

Patients present with a dry parched mouth and extreme thirst due to polyuria, a symptom of hyperglycemia.

Hyperosmolar hyperglycemic state may induce confusion, weakness, trouble talking, seizures, hallucinations, coma, or signs and symptoms that mimic a stroke.

Tachycardia and hypotension occur as a compensatory mechanism to the decreased blood volume and cardiac output. This decrease in body fluid is due to the polyuria and excessive dehydration of HHS.

Rehydrate patients slowly to prevent cerebral edema. Be cautious when rehydrating the elderly, CHF patients, and renal disease patients.

Patients in HHS aren't producing enough insulin to counteract the hyperglycemia, so insulin must be administered.

Treat the underlying cause of HHS. Possible precipitating factors of HHS include burns, severe diarrhea, medications, uncontrolled diabetes, or myocardial infarction.