a) Outline the distinguishing features that differentiate between diabetic ketoacidosis (OKA) and
hyperosmolar hyperglycaemic state (HHS). (70% marks)
b) List six possible complications seen during treatment of HHS. (30% marks)
Additional Examiners‟ Comments:
There was a lack of reference to clinical features. Surprisingly few candidates mentioned the presence of ketones and ketoacidosis as a distinguishing feature.
Most intelligent people would view the presence of ketones and acidosis in ketoacidosis to be so obvious that it does not merit a mention in a serious discussion. However, it appears to have been one of the tickboxes for the marking examiners. Let that be a lesson to all us candidates. Next time in an exam answer regarding lactic acidosis, be sure to strongly stress the fact that lactate and acidaemia are cardinal features.
This question closely resembles the first part of Question 17 from the first paper of 2014.
Features suggestive of DKA
Features suggestive of HONK
The following list of complications of HHS is a combination of several sources, including local resources as well as the college answers to Question 18.1 from the second paper of 2008 and Question 13 from the first paper of 2002.
Hyperglycemic Comas by P. VERNON VAN HEERDEN from Vincent, Jean-Louis, et al. Textbook of Critical Care: Expert Consult Premium. Elsevier Health Sciences, 2011.
Oh's Intensive Care manual: Chapter 58 (pp. 629) Diabetic emergencies by Richard Keays
Gerich, John E., Malcolm M. Martin, and Lillian Recant. "Clinical and metabolic characteristics of yperosmolar nonketotic coma." Diabetes 20.4 (1971): 228-238.
Kitabchi, Abbas E., et al. "Hyperglycemic crises in adult patients with diabetes." Diabetes care 32.7 (2009): 1335-1343.
Kitabchi, Abbas E., et al. "Hyperglycemic crises in adult patients with diabetes a consensus statement from the American Diabetes Association." Diabetes care 29.12 (2006): 2739-2748.
Hegazi, Mohamed Osama, and Anant Mashankar. "Central pontine myelinolysis in the hyperosmolar hyperglycaemic state." Medical Principles and Practice 22.1 (2013): 96-99.