What is the cornerstone treatment for hyperosmolar hyperglycemic state?

• A. IV fluids and insulin
• B. Oral hypoglycemics
• C. Intravenous diuretics
• D. Glucagon therapy

Answer: (A)

In hyperosmolar hyperglycemic state, the foundational approach is to restore perfusion and then correct the high blood glucose with insulin. Start with aggressive IV fluids, typically isotonic saline, to rehydrate the patient and improve organ perfusion. Once volume status is improving and glucose is trending downward toward 200–250 mg/dL, begin insulin therapy to correct the hyperglycemia and reduce serum osmolarity, while continuing fluids and monitoring. Switch to dextrose-containing fluids as needed to prevent hypoglycemia once glucose nears the 200–250 range, all the while titrating insulin to avoid rapid shifts in osmolality. Throughout, closely monitor and correct electrolytes, especially potassium, because insulin and fluid therapy can cause potassium to move into cells and total body potassium is often depleted despite normal or high initial serum levels. Address the precipitating trigger and ensure supportive care. Oral hypoglycemics, intravenous diuretics, and glucagon are not appropriate cornerstone therapies for this acute state.