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HHS treatment complication — SCE Endocrinology MCQ

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HardDiabetic emergenciesHHS treatment complicationSCE Endocrinology

A 47-year-old man is treated for HHS. Initial sodium is 150 mmol/L, glucose 54 mmol/L and osmolality 360 mOsm/kg. After 4 hours of fluids, glucose has fallen to 24 mmol/L and osmolality to 310 mOsm/kg; he becomes drowsier. What is the most likely management error?

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Correct answer: C — Osmolality has fallen too rapidly during treatment

Osmolality has fallen too rapidly during treatment is best because HHS requires gradual osmolality correction because rapid shifts can worsen neurological status. The alternatives are less appropriate because delaying insulin initially is often appropriate; potassium checks are essential; isotonic saline is standard initial fluid; ketone measurement helps distinguish DKA overlap. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: JBDS-IP HHS guideline