From the Research
High sugar OHSS is a life-threatening condition that requires immediate medical attention, and the most effective management strategy involves aggressive fluid resuscitation, correction of electrolyte abnormalities, and close monitoring of the patient's condition, as recommended by the most recent guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care Group 1.
Diagnosis and Management
The diagnosis of high sugar OHSS is based on the presence of marked hyperglycemia, hyperosmolarity, and minimal or absent ketosis, along with neurologic symptoms such as altered mental status 2. The management of high sugar OHSS involves:
- Aggressive fluid resuscitation with intravenous 0.9% sodium chloride to restore circulating volume 1
- Correction of electrolyte abnormalities, particularly potassium replacement according to potassium levels 1
- Fixed rate intravenous insulin infusion (FRIII) to control hyperglycemia, once osmolality stops falling with fluid replacement 1
- Glucose infusion (5% or 10%) to maintain blood glucose levels between 10-15 mmol/L 1
Prevention of Complications
It is essential to prevent complications such as thrombosis, cerebral edema, and foot ulceration by:
- Maintaining adequate hydration to prevent hypercoagulability 1
- Avoiding overcorrection of osmolality, sodium, and other electrolytes 2
- Monitoring urine output and adjusting fluid replacement accordingly 1
- Identifying and treating underlying precipitants of high sugar OHSS, such as infections or non-adherence to therapy 3
Outcome
The outcome of high sugar OHSS depends on the severity of the condition, the presence of comorbidities, and the promptness and effectiveness of treatment. With proper management, the mortality rate can be reduced, and the quality of life can be improved 4. However, delayed or inadequate treatment can lead to severe complications and high mortality rates 4.