Endocrine Abstracts

Introduction: We audited the management of HHS based on JBDS guidelines.

Methods: Data was collected from January 2023 to August 2024 and 19 patients with glucose ≥30 mmol/l, serum osmolality ≥320 mOsm/kg, and absence of significant ketoacidosis (pH ≥7.3 / bicarbonate ≥15 mmol/l) were identified.

Results: Only 58% (n 11) had Osmolality calculated and documented in the notes to make the diagnosis. In addition to osmolality 68% (n 13) had documented PH, Blood glucose and ketone levels. 63%(n12) had at least 1 litre of 0.9% normal saline in first hour. In first 6 hours 26% (n 5) had had hourly documentation of fall in osmolarity (targeted at 3-8mOsmol/kg/hr). Where the aim was not achieved, insulin was commenced after 1 hour at 0.05 units/kg/hr for 89% (n 17). 100% (1 patient) had their fluid changed to 0.45% saline when Osmolarity had increased despite correct fluid. 75% (n 3) were commenced on Dextrose or had their insulin reduced when capillary blood glucose (CBG) <14 mmol/L & 25% (n 1) didn’t have dextrose/insulin reduced. 94% (18 patients) had either VRII or Subcutaneous insulin prescribed by 24 - 72 hours when their Biochemistry Sodium, CBG/osmolarity had normalised. 100% (3 patients) with osmolarity >350 mosm/kg, Na > 160mmol/l; K > 6 or < 3.5 mmol/l; GCS <12 or abnormal AVPU had review by ITU or decision about their escalation made.

Conclusion: Despite JBDS guidelines having been around for several years, there remains potential areas for improvement in care. Calculating osmolality, fluid management and monitoring of response to treatment were areas identified for improvement. PDSA cycle of educational meetings on the diagnosis & management of HHS have been planned.