Hyperosmolar hyperglycaemic state

Establish a monitoring regimen for your patient according to your local protocol. In general this should include:

• Hourly blood glucose for the first 24 hours; hourly sodium, potassium, urea, and calculated serum osmolality for the first 6 hours, which can be reduced to every 2 hours after 6 hours if serum osmolality is decreasing by 3 to 8 mOsm/kg/hour (3-8 mmol/kg/hour)

  • Monitoring of sodium, potassium, urea, and serum osmolality may be reduced to every 4 hours after 12 hours if the patient is continuing to improve[6]Joint British Diabetes Societies for Inpatient Care Group. The management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes. Feb 2022 [internet publication]. https://abcd.care/resource/jbds-06-management-hyperosmolar-hyperglycaemic-state-hhs-adults-diabetes

• Continuous pulse oximetry[6]Joint British Diabetes Societies for Inpatient Care Group. The management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes. Feb 2022 [internet publication]. https://abcd.care/resource/jbds-06-management-hyperosmolar-hyperglycaemic-state-hhs-adults-diabetes

• Continuous cardiac monitoring if necessary[6]Joint British Diabetes Societies for Inpatient Care Group. The management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes. Feb 2022 [internet publication]. https://abcd.care/resource/jbds-06-management-hyperosmolar-hyperglycaemic-state-hhs-adults-diabetes

• Vital signs including early warning score (EWS).

In practice, monitoring intervals may vary and measurement of serum osmolality to monitor the patient's response to treatment may not be commonly used; check your local protocol. As an alternative:

• Reduce monitoring of blood glucose to every 2 hours after 6 hours if the blood glucose is stable (around 12-15 mmol/L [216-270 mg/dL]).

• Reduce monitoring of sodium, potassium, and urea to every 2 hours after 6 hours if these are improving.