Hyperosmolar Hyperglycaemic State: An 81-Year-Old Woman with Profound Dehydration
A branching clinical case simulation for a patient presenting with progressive drowsiness and polyuria for 2 days. Take a history, examine, investigate, diagnose and treat while the patient responds to every decision, then see the score by clinical domain with the reasoning for each mark.
Year 4medium20 min6 stages
- Patient
- 81 years, female
- Presenting complaint
- Progressive drowsiness and polyuria for 2 days
- Decision stages
- History, Examination, Investigations, Diagnosis, Treatment, Monitoring
The presentation
An 81-year-old woman is brought to the emergency department by her daughter. She has type 2 diabetes treated with metformin and gliclazide. Over the past 2 days, she has become increasingly drowsy and has been passing large volumes of urine. The daughter says she has not eaten much and has barely drunk any fluids. She has also been coughing for a week. On arrival, the patient is somnolent but rousable, with a dry mouth and poor skin turgor. Her daughter asks you to 'do something'.
What this case teaches
Distinguish hyperosmolar hyperglycaemic state (HHS) from diabetic ketoacidosis (DKA); rehydrate first and lower glucose slowly; anticoagulate; find the precipitant; monitor sodium and osmolality.
How the case unfolds
- 1Focused HistoryHistory
- 2Focused ExaminationExamination
- 3Initial InvestigationsInvestigations
- 4Making the DiagnosisDiagnosis
- 5Initial TreatmentTreatment
- 6Monitoring and Ongoing CareMonitoring
The decisions available at each stage, and what each one costs or earns, appear when you run the case.
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A free account opens the simulator: the patient's observations move with your decisions, and every choice is scored and explained.
Taught in
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.