Endocrine & metabolic · UKMLA & AKT
Hyperosmolar hyperglycaemic state
A free high-yield preview for the UKMLA Applied Knowledge Test. Below are the key points to recognise hyperosmolar hyperglycaemic state — the full SA Note notes add investigations, management, complications and 10 practice questions.
Key high-yield points
- HHS is a life-threatening metabolic emergency in type 2 diabetes: profound hyperglycaemia + hyperosmolality + NO significant ketosis/acidosis.
- JBDS diagnostic criteria - all four must be present:
- Hypovolaemia - clinically evident dehydration
- Hyperglycaemia - blood glucose >30 mmol/L
- Hyperosmolality - serum osmolality >320 mOsm/kg
- No significant hyperketonaemia (blood ketones <3 mmol/L) and no significant acidosis (pH >7.3, bicarbonate >15 mmol/L)
Why no ketones? Residual basal insulin in type 2 diabetes is enough to suppress lipolysis and inhibit ketogenesis - even though it cannot control glucose. This is the key distinction from DKA.
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