There have been case reports described in the literature of adolescents presenting with diabetes mellitus and HHNS that developed high fever, rhabdomyolysis and cardiac instability.
Guidelines for current treatment of HHNS include initial resuscitation with crystalloid replacement and correction of hyperglycemia and hyperosmolality by ongoing fluid administration and insulin therapy.
Cost and the time it takes to administer a treatment and care for the equipment are concerns but HHNs or SVNs remain effective ways of delivering a respiratory medication.
In terms of guidelines for clinical use, HHNs or SVNs should be considered when a patient is unable to follow instructions for MDI or DPI use or is disoriented, has a poor inspiratory capacity, is incapable of a breath hold, is tachypneic (RR greater than 25/minute), needs to aerosolize a drug not in MDI or DPI form and needs to consider costs.
Acute complications of diabetes are: hypoglycaemia, diabetic ketoacidosis (DKA), and hyperosmolar hyperglycaemic non-ketotic syndrome (HHNS, sometimes referred to as HONK).
HHNS Lacks symptoms of ketoacidosis so there is often a more profound dehydration (10 or more litres of body water, compared with four to seven litres in DKA) and higher PGC when the person finally presents.