From the Research
High sugar OHSS requires immediate medical attention and management to prevent significant morbidity and mortality, with the primary goal of correcting fluid losses, electrolyte imbalances, and hyperglycemia. The management of high sugar OHSS involves a comprehensive approach, including:
- Fluid resuscitation with intravenous 0.9% sodium chloride to restore circulating volume, with caution in elderly patients [ 1 ]
- Fixed rate intravenous insulin infusion (FRIII) to control blood glucose levels, with dosing individualized based on glucose readings [ 1 ]
- Potassium replacement according to potassium levels to prevent hypokalaemia [ 1 ]
- Monitoring of osmolality, blood glucose, and electrolyte levels to prevent overcorrection and minimize the risk of neurological complications [ 1 ]
- Identification and treatment of underlying precipitants, such as infection or other comorbidities [ 1 ]
- Consideration of immunoglobulin treatment in severe refractory cases [ 2 ]
The connection between OHSS and hyperglycemia stems from the inflammatory response and fluid shifts that can disrupt glucose metabolism [ 3 ]. Patients with pre-existing diabetes or insulin resistance are at higher risk and should be monitored more closely [ 4 ]. Daily weight measurements and tracking abdominal circumference can help assess fluid retention, while symptoms like severe abdominal pain, shortness of breath, or decreased urination warrant immediate medical attention [ 5 ].
The management of high sugar OHSS should be guided by the most recent and highest quality evidence, with a focus on preventing significant morbidity and mortality [ 1 ]. The Joint British Diabetes Societies (JBDS) guideline for the management of Hyperosmolar Hyperglycaemic State (HHS) provides a comprehensive framework for the diagnosis, management, and disposition of patients with HHS [ 1 ].
In terms of specific medications, insulin therapy may be necessary to control blood glucose levels, with dosing individualized based on glucose readings [ 1 ]. Metformin may help improve insulin sensitivity, but its use should be cautious in patients with renal impairment or other comorbidities [ 4 ].
Overall, the management of high sugar OHSS requires a comprehensive and individualized approach, with a focus on preventing significant morbidity and mortality.