Question

A 78-year-old man with type 2 diabetes, confusion, glucose 40 mmol/L, osmolality high, minimal ketones and normal pH is diagnosed with hyperosmolar hyperglycaemic state (HHS). What is the main initial treatment priority?

Accepted Answer

Aggressive IV fluid replacement with careful monitoring, starting insulin later at low dose

Answer

Rapid high-dose IV insulin bolus

Answer

Immediate bicarbonate infusion

Answer

Oral Metformin restart

Answer

No IV fluids to avoid overload

Practice question

A 78-year-old man with type 2 diabetes, confusion, glucose 40 mmol/L, osmolality high, minimal ketones and normal pH is diagnosed with hyperosmolar hyperglycaemic state (HHS). What is the main initial treatment priority?