From the Research
Dexamethasone is generally preferred over methylprednisolone for the treatment of hyperosmolar hyperglycemic state (HHS) due to its longer duration of action and greater potency, although the provided evidence does not directly compare the two in this context, the most recent guideline recommends the use of glucocorticoids in general for HHS treatment 1.
Key Considerations
- The management of HHS involves aggressive fluid replacement, insulin therapy, and treatment of the underlying cause, with the goal of improving clinical status, replacing fluid losses, and preventing complications 2, 1.
- The use of glucocorticoids, such as dexamethasone, may be beneficial in certain cases of HHS, particularly when there is an underlying inflammatory or infectious process 1.
- The choice between dexamethasone and methylprednisolone should be based on individual patient factors, such as the severity of the condition, the presence of comorbidities, and the potential for adverse effects.
Treatment Approach
- Aggressive fluid replacement with 0.9% sodium chloride to restore circulating volume, with caution in elderly patients 2, 3.
- Fixed rate intravenous insulin infusion (FRIII) should be commenced once osmolality stops falling with fluid replacement, unless there is ketonaemia 2.
- Glucose infusion (5% or 10%) should be started once glucose <14 mmol/L 2.
- Potassium replacement according to potassium levels 2, 3.