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Dka Vs Hhs Nursing

Diabetic Ketoacidosis And Hyperglycaemic Hyperosmolar State

Diabetic Ketoacidosis And Hyperglycaemic Hyperosmolar State

The hallmark of diabetes is a raised plasma glucose resulting from an absolute or relative lack of insulin action. Untreated, this can lead to two distinct yet overlapping life-threatening emergencies. Near-complete lack of insulin will result in diabetic ketoacidosis, which is therefore more characteristic of type 1 diabetes, whereas partial insulin deficiency will suppress hepatic ketogenesis but not hepatic glucose output, resulting in hyperglycaemia and dehydration, and culminating in the hyperglycaemic hyperosmolar state. Hyperglycaemia is characteristic of diabetic ketoacidosis, particularly in the previously undiagnosed, but it is the acidosis and the associated electrolyte disorders that make this a life-threatening condition. Hyperglycaemia is the dominant feature of the hyperglycaemic hyperosmolar state, causing severe polyuria and fluid loss and leading to cellular dehydration. Progression from uncontrolled diabetes to a metabolic emergency may result from unrecognised diabetes, sometimes aggravated by glucose containing drinks, or metabolic stress due to infection or intercurrent illness and associated with increased levels of counter-regulatory hormones. Since diabetic ketoacidosis and the hyperglycaemic hyperosmolar state have a similar underlying pathophysiology the principles of treatment are similar (but not identical), and the conditions may be considered two extremes of a spectrum of disease, with individual patients often showing aspects of both. Pathogenesis of DKA and HHS Insulin is a powerful anabolic hormone which helps nutrients to enter the cells, where these nutrients can be used either as fuel or as building blocks for cell growth and expansion. The complementary action of insulin is to antagonise the breakdown of fuel stores. Thus, the relea Continue reading >>

Management Of Diabetic Ketoacidosis And Other Hyperglycemic Emergencies

Management Of Diabetic Ketoacidosis And Other Hyperglycemic Emergencies

Understand the management of patients with diabetic ketoacidosis and other hyperglycemic emergencies. ​ The acute onset of hyperglycemia with attendant metabolic derangements is a common presentation in all forms of diabetes mellitus. The most current data from the National Diabetes Surveillance Program of the Centers for Disease Control and Prevention estimate that during 2005-2006, at least 120,000 hospital discharges for diabetic ketoacidosis (DKA) occurred in the United States,(1) with an unknown number of discharges related to hyperosmolar hyperglycemic state (HHS). The clinical presentations of DKA and HHS can overlap, but they are usually separately characterized by the presence of ketoacidosis and the degree of hyperglycemia and hyperosmolarity, though HHS will occasionally have some mild degree of ketosis. DKA is defined by a plasma glucose level >250 mg/dL, arterial pH <7.3, the presence of serum ketones, a serum bicarbonate measure <18 mEq/L, and a high anion gap metabolic acidosis. The level of normal anion gap may vary slightly by individual institutional standards. The anion gap also needs to be corrected in the presence of hypoalbuminemia, a common condition in the critically ill. Adjusted anion gap = observed anion gap + 0.25 * ([normal albumin]-[observed albumin]), where the given albumin concentrations are in g/L; if given in g/dL, the correction factor is 2.5.(3) HHS is defined by a plasma glucose level >600 mg/dL, with an effective serum osmolality >320 mOsm/kg. HHS was originally named hyperosmolar hyperglycemic nonketotic coma; however, this name was changed because relatively few patients exhibit coma-like symptoms. Effective serum osmolality = 2*([Na] + [K]) + glucose (mg/dL)/18.(2) Urea is freely diffusible across cell membranes, thus it will Continue reading >>

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State

Hyperosmolar hyperglycemic state (HHS) is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis.[4] Symptoms include signs of dehydration, weakness, legs cramps, trouble seeing, and an altered level of consciousness.[2] Onset is typically over days to weeks.[3] Complications may include seizures, disseminated intravascular coagulopathy, mesenteric artery occlusion, or rhabdomyolysis.[2] The main risk factor is a history of diabetes mellitus type 2.[4] Occasionally it may occur in those without a prior history of diabetes or those with diabetes mellitus type 1.[3][4] Triggers include infections, stroke, trauma, certain medications, and heart attacks.[4] Diagnosis is based on blood tests finding a blood sugar greater than 30 mmol/L (600 mg/dL), osmolarity greater than 320 mOsm/kg, and a pH above 7.3.[2][3] Initial treatment generally consists of intravenous fluids to manage dehydration, intravenous insulin in those with significant ketones, low molecular weight heparin to decrease the risk of blood clotting, and antibiotics among those in whom there is concerns of infection.[3] The goal is a slow decline in blood sugar levels.[3] Potassium replacement is often required as the metabolic problems are corrected.[3] Efforts to prevent diabetic foot ulcers are also important.[3] It typically takes a few days for the person to return to baseline.[3] While the exact frequency of the condition is unknown, it is relatively common.[2][4] Older people are most commonly affected.[4] The risk of death among those affected is about 15%.[4] It was first described in the 1880s.[4] Signs and symptoms[edit] Symptoms of high blood sugar including increased thirst (polydipsia), increased volume of urination (polyurea), and i Continue reading >>

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State

You arrive in the emergency department of a small hospital where your patient is waiting. Mr Smith is a 64 year old of Portuguese descent with type 2 diabetes, chronic hepatitis B, CVA 2 years ago, CAD, and hypertension. His home medications include metoprolol, aspirin, atorvastatin, lisinopril, furosemide and metformin. His daughter is at the bedside and reports he had been doing well until last week when he appeared depressed and had not been taking his medications on time. When she checked on him today he was difficult to wake and could not sit up in bed. EMS transported to the hospital. Now he appears weak, and is very slow to respond. His speech is clear. He is able to move all four extremities with no unilateral deficits. B/P 88/56, pulse is 118, respritory rate 22. Oral temp is 37.4 C. His lungs are clear, cardiac exam shows S1, S2 without murmur or gallop. His abdomen is soft and nontender. Lab results are: Sodium 138mEq/L K+ 4.9 mEq/L, Cl 88 mEq/L, HCO3 35 mEq/L, BUN 99 mg/dL Creatinine 4.3 mg/dL, glucose 1130 mg/dL Arterial blood gas: pH 7.40 PCO2 35 mmHg PO2 88 mmHg WBC 8.4 k Serum ketones: negative Urinalysis: 2+ protein, 4+ glucose, no ketones Is this data complete enough to make a diagnosis? What are the pertinent results to do so? Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are two of the most serious metabolic complications of diabetes. While DKA is more common, HHS has a higher mortality rate. In adult subjects with DKA overall mortality is <1%, mortality figures for HHS range from 5 to 20%.1,2 Death is usually due in part to a comorbid illness so detection and treatment of the underlying illness should be included. HHS is the result of a sustained osmotic diuresis, typically over several days to weeks. It is characterized by Continue reading >>

Dka Vs Hhs (hhns) Nclex Review

Dka Vs Hhs (hhns) Nclex Review

Diabetic ketoacidosis vs hyperglycemic hyperosmolar nonketotic syndrome (HHNS or HHS): What are the differences between these two complications of diabetes mellitus? This NCLEX review will simplify the differences between DKA and HHNS and give you a video lecture that easily explains their differences. Many students get these two complications confused due to their similarities, but there are major differences between these two complications. After reviewing this NCLEX review, don’t forget to take the quiz on DKA vs HHNS. Lecture on DKA and HHS DKA vs HHNS Diabetic Ketoacidosis Affects mainly Type 1 diabetics Ketones and Acidosis present Hyperglycemia presents >300 mg/dL Variable osmolality Happens Suddenly Causes: no insulin present in the body or illness/infection Seen in young or undiagnosed diabetics Main problems are hyperglycemia, ketones, and acidosis (blood pH <7.35) Clinical signs/symptoms: Kussmaul breathing, fruity breath, abdominal pain Treatment is the same as in HHNS (fluids, electrolyte replacement, and insulin) Watch potassium levels closely when giving insulin and make sure the level is at least 3.3 before administrating. Hyperglycemic Hyperosmolar Nonketotic Syndrome Affects mainly Type 2 diabetics No ketones or acidosis present EXTREME Hyperglycemia (remember heavy-duty hyperglycemia) >600 mg/dL sometimes four digits High Osmolality (more of an issue in HHNS than DKA) Happens Gradually Causes: mainly illness or infection and there is some insulin present which prevents the breakdown of ketones Seen in older adults due to illness or infection Main problems are dehydration & heavy-duty hyperglycemia and hyperosmolarity (because the glucose is so high it makes the blood very concentrated) More likely to have mental status changes due to severe dehydrat Continue reading >>

Diabetic Ketoacidosis And Hyperosmolar Hyperglycemia — A Brief Review

Diabetic Ketoacidosis And Hyperosmolar Hyperglycemia — A Brief Review

Diabetic Ketoacidosis and Hyperosmolar Hyperglycemia — A Brief Review SPECIAL FEATURE By Richard J. Wall, MD, MPH, Pulmonary Critical Care & Sleep Disorders Medicine, Southlake Clinic, Valley Medical Center, Renton, WA. Dr. Wall reports no financial relationships relevant to this field of study. Financial Disclosure: Critical Care Alert's editor, David J. Pierson, MD, nurse planner Leslie A. Hoffman, PhD, RN, peer reviewer William Thompson, MD, executive editor Leslie Coplin, and managing editor Neill Kimball report no financial relationships relevant to this field of study. INTRODUCTION Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are two of the most common and serious acute complications of diabetes mellitus. DKA is responsible for more than 500,000 hospital days annually in the United States, at an estimated annual cost of $2.4 billion. Both conditions are part of the spectrum of uncontrolled hyperglycemia, and there is sometimes overlap between them. This article will discuss and compare the two conditions, with a focus on key clinical features, diagnosis, and treatment. DIAGNOSTIC FEATURES In DKA, there is an accumulation of ketoacids along with a high anion gap metabolic acidosis (see Table below).1 The acidosis usually evolves quickly over a 24-hour period. The pH is often < 7.20 and initial bicarbonate levels are often < 20 mEq/L. DKA patients (especially children) often present with nausea, vomiting, hyperventilation, and abdominal pain. Blood sugar levels in DKA tend to be 300-800 mg/dL, but they are sometimes much higher when patients present in a comatose state. In HHS, there is no (or little) ketonemia but the plasma osmolality may reach 380 mOsm/kg, and as a result, patients often have neurologic complications such as coma. Bica Continue reading >>

Dka Vs Hhs

Dka Vs Hhs

Filme, Clips - kostenlos ansehen, online teilen Session 5 - Difference Between Diabetic Ketoacidosis ( DKA ) And Hyperosmoler Hyperglycemic ( HHS ) ( Dr/ Razan Agha ) Case 835 * DKA & HHS Part 2 * Dr. Akram Mohammad Babury, MD ... Compare and contrast Hypoglycemia, Diabetic Ketoacidosis, and Hyperglycemic Hyperosmolar State (aka HyperOsmolar Non-Ketotosis; aka HONK). Briefly cover the pathophysiology, major defect,... Case 835 * DKA & HHS Part 2 ... Dr. Mohammad Ajmal Yasin, MD .... Discussion about diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Such as stroke or myocardial infarction, can cause this state dec 7, 2016 diabetic ketoacidosis (dka) and hyperosmolar hyperglycemic... Case 834 * DKA & HHS Part 1 * Dr. Mohammad Akram Babury, MD ... A lecture on the recognition, pathogenesis, and treatment of diabetic ketoacidosis and the hyperosmolar hyperglycemic state. Hyperglycemic crises: Hyperglycemic hyperosmolar nonketotic coma (HHNK) versus DKA. See DKA video here: de-film.com/v-video-r2tXTjb7EqU.html This video and similar images/videos are available for instant... What is diabetes mellitus? Diabetes mellitus is when there's too much glucose, a type of sugar, in the blood. Diabetes mellitus can be split into type 1, type 2, as well as a couple other subtypes,... Visit us (www.khanacademy.org/science/healthcare-and-medicine) for health and medicine content or (www.khanacademy.org/test-prep/mcat) for MCAT related content. These videos do... www.tootRN.com Instagram: tootRN Learn the basic concept of DKA and HHS, and be prepared for your class lecture! Build the base of your DKA and HHS knowledge here!... feel free to giggle at... Visit us (www.khanacademy.org/science/healthcare-and-medicine) Continue reading >>

Hyperglycemic Crises: Diabetic Ketoacidosis (dka), And Hyperglycemic Hyperosmolar State (hhs)

Hyperglycemic Crises: Diabetic Ketoacidosis (dka), And Hyperglycemic Hyperosmolar State (hhs)

Go to: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of DKA and HHS. Critical components of the hyperglycemic crises management include coordinating fluid resuscitation, insulin therapy, and electrolyte replacement along with the continuous patient monitoring using available laboratory tools to predict the resolution of the hyperglycemic crisis. Understanding and prompt awareness of potential of special situations such as DKA or HHS presentation in comatose state, possibility of mixed acid-base disorders obscuring the diagnosis of DKA, and risk of brain edema during the therapy are important to reduce the risks of complications without affecting recovery from hyperglycemic crisis. Identification of factors that precipitated DKA or HHS during the index hospitalization should help prevent subsequent episode of hyperglycemic crisis. For extensive review of all related areas of Endocrinology, visit WWW.ENDOTEXT.ORG. Go to: INTRODUCTION Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) represent two extremes in the spectrum of decompensated diabetes. DKA and HHS remain important causes of morbidity and mortality among diabetic patients despite well developed diagnostic criteria and treatment protocols (1). The annual incidence of DKA from population-based studies is estimated to range from 4 to 8 episodes per 1,000 patient admissions with diabetes (2). The incidence of DKA continues to increase and it accounts for about 140,000 hospitalizations in the US in 2009 (Figure 1 a) (3). Continue reading >>

4 Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Nonketotic Syndrome Nursing Care Plans

4 Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Nonketotic Syndrome Nursing Care Plans

Risk for Fluid Volume Deficit: At risk for experiencing vascular, cellular, or intracellular dehydration. Risk Factors Decreased intake of fluids due to diminished thirst sensation or functional inability to drink fluids. Excessive gastric losses due to nausea and vomiting. Hyperglycemia-induced osmotic diuresis. Possibly evidenced by [not applicable]. Desired Outcomes Client will remain normovolemic as evidenced by urinary output greater than 30 ml/hr, normal skin turgor, good capillary refill, normal blood pressure, palpable peripheral pulses, and blood glucose levels between 70-200 mg/dL. Nursing Interventions Rationale Assess precipitating factors such as other illnesses, new-onset diabetes, or poor compliance with treatment regimen. These will provide baseline data for education once with resolved hyperglycemia. Urinary tract infection and pneumonia are the most common infections causing DKA and HHNS among older clients. Assess skin turgor, mucous membranes, and thirst. To provide baseline data for further comparison. Skin turgor will decrease and tenting may occur. The oral mucous membranes will become dry, and the client may experience extreme thirst. Monitor hourly intake and output. Oliguria or anuria results from reduced glomerular filtration and renal blood flow. Monitor vital signs: Monitor BP especially for orthostatic hypotension. Decreased blood volume may be manifested by a drop in systolic blood pressure and orthostatic hypotension. Monitor respirations, e.g., acetone breath, Kussmaul’s respirations. Acetone breath is due to the breakdown of acetoacetic acid. Kussmaul’s respiration (rapid and shallow breathing) represent a compensatory mechanism by the respiratory buffering system to raise arterial pH by exhaling more carbon dioxide. Monitor tempera Continue reading >>

Free Unfinished Flashcards About Dka & Hhs

Free Unfinished Flashcards About Dka & Hhs

1) infection; 2) D/C Meds or inadequate therapy3) trauma; 4) med/surg illnesses -Polyuria-polydypsia-polyphagia with weight loss-Weakness-N/V-A-pain So what are you critically thinking about when you first lay eyes on the patient ? -always think airway.-Breath smells fruity odor so when your burning ketones, you know the pt is diabetic. -CENTRAL-RESPIRATORY-MUSCLUAR-INTESTINAL-RESPIRATORY (SOB, coughing)-HEART (^HR, Arrythmias)-GAStric (NV) Pathophysiology - DKA1. Loss of insulin dependent glucose transport into?2. Increased in liver?3. Increased breakdown of?4. Hyperglycemia- BG >?5. _ketone___/____6. Acidosis pH <_____________?7. HCO3 <_____________ Pathophysiology - DKA1. peripheral tissues2. gluconeogenesis3. fat, protein, and glycogen4. 200mg/dL5. Ketonemia/ketonuria6. pH < 7.3 7. <15 Hyperglycemia:1. above renal threshhold: > ________2. > 180-200 BG is_______________3. Osmotic diuresis drags solutes (Na, K, Cl, PO4) with it leading to loss of ---------> Hyperglycemia1. > 180-200 2. glycosUria3. Dehyration & Electrolyte loss Dehydration:1. aggrivates existing______________2. Lactic ________ Dehydration:1. ketoacidosis2. lactic acidosis HHS:1. Altered sensorium without __________?2. critical deficit of what but enought to prevent ketonemia?2. there is profound what?4. severe loss of ?5. PLASMA GLUCOSE >______?6. SERUM OSMOLARITY >_______?7.SERUM CO2 is >___ HHS:1. true coma2. Insulin3. Dehydration4. Electrolytes5. > 6006. > 3207. >15 (HHS) is a serious complication of ____ that involves a cycle of increasing______levels and ____, without ____ type 2 diabetes, but it can also occur with type 1 diabetes. HHS IS often triggered by?serious ____ or another severe _____, or by medications that lower glucose tolerance or increase _____ (especially in people who are not dr Continue reading >>

Management Of Acute Hyperglycemic Emergencies: Focus On Diabetic Ketoacidosis

Management Of Acute Hyperglycemic Emergencies: Focus On Diabetic Ketoacidosis

Activity Summary Diabetes mellitus (DM) is a chronic disease diagnosed in 20.9 million Americans; in addition, many people have undiagnosed DM. In 2011, the incidence of new diagnoses of DM was approximately 1.7 million and has increased every year since 1995. A severe acute metabolic complication of DM is diabetic ketoacidosis (DKA), which is listed as the primary diagnosis in approximately 7 patients with DM per 1000 hospital discharges and is associated with an average hospital length of stay of 3.4 days. Diabetic emergencies are twice as common in females. The annual expenditure for patients with DKA has been estimated at $2.4 billion. Objectives Identify signs and symptoms of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Identify treatment measures for DKA and HHS. Review key points of patient education to help decrease hospital readmissions. Continuing Education Disclosure Statement Continue reading >>

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State

Dr. Richard Hellman, past president of the American Association of Clinical Endocrinologists, remembers once seeing a man whose blood glucose level was 2,400 mg/dl. “Basically,” he said, “his blood looked like syrup.” However, the man was not experiencing diabetic ketoacidosis (DKA). Instead, he had a condition called hyperosmolar hyperglycemic state, or HHS. Like DKA, HHS is characterized by very high blood glucose levels, but unlike in DKA, people with HHS do not generally have ketones in their blood or urine. Nonetheless, HHS can be deadly. According to the American Diabetes Association (ADA), while DKA has a death rate of less than 5%, that figure can reach around 15% for HHS. Luckily, HHS is rare. The ADA says the annual rate for DKA ranges from 4.6 to 8 episodes per 1,000 people admitted to the hospital. HHS accounts for less than 1% of hospital admissions related primarily to diabetes. HHS is most common in elderly people with new-onset Type 2 diabetes, particularly those who live in nursing homes, or in older people who have been diagnosed with Type 2 diabetes but who are unaware that their blood glucose is high or who haven’t had enough fluid intake. Compounding the problem is that the thirst mechanism can be impaired in older people, and they’re more apt to have kidney problems, Dr. Hellman says. When a person’s thirst mechanism is impaired, the kidneys — which normally work to remove excess glucose from the blood — begin to conserve water. That leads to a higher glucose concentration in the bloodstream. In many people, HHS begins with an infection, such as a urinary tract infection or pneumonia. Unlike DKA, which develops relatively quickly, HHS develops over several days, or even weeks. “Diagnosis is sometimes a problem,” Dr. Hellman sa Continue reading >>

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State

Background Hyperosmolar hyperglycemic state (HHS) is one of two serious metabolic derangements that occurs in patients with diabetes mellitus (DM). [1] It is a life-threatening emergency that, although less common than its counterpart, diabetic ketoacidosis (DKA), has a much higher mortality rate, reaching up to 5-10%. (See Epidemiology.) HHS was previously termed hyperosmolar hyperglycemic nonketotic coma (HHNC); however, the terminology was changed because coma is found in fewer than 20% of patients with HHS. [2] HHS is most commonly seen in patients with type 2 DM who have some concomitant illness that leads to reduced fluid intake, as seen, for example, in elderly institutionalized persons with decreased thirst perception and reduced ability to drink water. [3] Infection is the most common preceding illness, but many other conditions, such as stroke or myocardial infarction, can cause this state. [3] Once HHS has developed, it may be difficult to identify or differentiate it from the antecedent illness. (See Etiology.) HHS is characterized by hyperglycemia, hyperosmolarity, and dehydration without significant ketoacidosis. Most patients present with severe dehydration and focal or global neurologic deficits. [2, 4, 5] The clinical features of HHS and DKA overlap and are observed simultaneously (overlap cases) in up to one third of cases. According to the consensus statement published by the American Diabetes Association, diagnostic features of HHS may include the following (see Workup) [4, 6] : Effective serum osmolality of 320 mOsm/kg or greater Profound dehydration, up to an average of 9L Detection and treatment of an underlying illness are critical. Standard care for dehydration and altered mental status is appropriate, including airway management, intravenous (I Continue reading >>

Acute Complications Of Diabetes - Hyperosmolar Hyperglycemic Nonketotic State

Acute Complications Of Diabetes - Hyperosmolar Hyperglycemic Nonketotic State

- [Voiceover] Diabetes mellitus and its associated complications are the 8th leading cause of death worldwide. Now normally we think of both type 1 and type 2 diabetes as being more chronic conditions that result in complications such as kidney disease and cardiovascular disease over years to decades. And this is true, but there are also a couple of very important acute complications of diabetes mellitus. And these are known as diabetic ketoacidosis, or DKA for short, and hyperosmolar hyperglycemic non-ketotic state, or HHNS for short. And unfortunately these acute complications can be very serious, especially HHNS, which has a mortality rate of eight to 20%. In this video, let's discuss hyperosmolar hyperglycemic non-ketotic state. Now the name hyperosmolar hyperglycemic non-ketotic state is pretty descriptive in regards to the metabolism that underlies the disease. However, it does not really describe the clinical presentation of the condition. So let's start with that. And most commonly, someone with HHNS has already been diagnosed with diabetes, and this occurs sometime after their initial diagnosis. And since they have diabetes, they likely will have hyperglycemia, which is one of the defining characteristics of diabetes mellitus. And as we'll discuss in just a minute, it's this hyperglycemia that's driving a lot of the events that are occurring in HHNS. Now over a period of days to weeks, someone with HHNS is gonna become pretty sick, and they're gonna have symptoms of fatigue, maybe some weight loss. They're gonna have extreme thirst and frequent urination. On physical exam they'll have signs of dehydration, such as a high heart rate, known as tachycardia, a low blood pressure known as hypotension, the mucus membranes in their mouth may be dry, and their skin may Continue reading >>

Hyperglycemia: Dka And Hhs

Hyperglycemia: Dka And Hhs

Anne Marie Mattingly Assistant Professor of Medicine Division of Pulmonary and Critical Care Goals of Treatment Accurately diagnose DKA and/or HHS Provide optimal volume resuscitation Use insulin to stop life-threatening metabolic derangements Correct dangerous electrolyte abnormalities Determine the precipitating factors and provide any urgent treatment Points To Learn Normal glucose metabolism Pathophysiology of hyperglycemic syndromes Basic management (and why it works) Fluids Insulin Electrolytes Common precipitating factors Transitioning to SQ insulin (and the floor) *these will parallel the goals of treatment…. 3 DKA, HHS, or neither? 47 year old with DM (on insulin) several days of nausea, vomiting, diarrhea, and abdominal pain missed insulin yesterday labs show: 133 3.5 107 16 34 2.6 407 ABG: pending UA: SpGrav 1.024, 1+ ketones DKA, HHS, or neither? 24 year old with DM (on insulin) several days of nausea, vomiting, diarrhea, and abdominal pain missed insulin yesterday labs show: 136 3.5 95 25 15 1.2 392 ABG: 7.38/38/95/25/99% RA *same symptoms, also missed his insulin *BG still elevated *bicarbonate is 25 and BUN/Cr not as high *pH normal 5 DKA, HHS, or neither? 81 year old SNF resident with DM (diet-controlled), aflutter, CAD, HTN referred to ED from SNF for chest pain, mental status change, and low BP EKG shows rapid a-fib (rate and pain resolve with IVF) labs show: 152 3.6 110 26 65 1.5 916 Lactate 4.0 *not even on insulin *sodium high, but bicarb normal and she has elevated lactate 6 DKA, HHS, or neither? 55 year old SNF resident with DM (on metformin), cerebral palsy, chronic constipation unable to stool for several days, today vomited repeatedly and then aspirated hypotensive and hypoxic labs show: 142 3.1 91 27 16 0.37 499 ABG: 7.47/31/105/22/96% o Continue reading >>

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