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Hyperosmolar Hyperglycaemic State

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Type 2 Diabetes article more useful, or one of our other health articles. Synonyms: hyperosmolar hyperglycaemic nonketotic coma (HONK), diabetic nonketotic coma, hyperosmolar nonketotic state, hyperosmolar nonketotic hyperglycaemia (HNKH) See also separate articles Coma, Diabetes and Intercurrent Illness, Management of Type 2 Diabetes Mellitus, Diabetic Ketoacidosis and Childhood Ketoacidosis. Hyperosmolar hyperglycaemic state (HHS) occurs in people with type 2 diabetes. Very high blood glucose levels (often over 40 mmol/L) develop as a result of a combination of illness, dehydration and an inability to take normal diabetes medication due to the effect of illness. HHS is characterised by severe hyperglycaemia with marked serum hyperosmolarity, without evidence of significant ketosis. HHS is a potentially life-threatening emergency. Hyperglycaemia causes an osmotic diuresis with hyperosmolarity leading to an osmotic shift of water into the intravascular compartment, resulting in severe intracellu Continue reading >>

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  1. Jeanwf

    Hi. Anyone out there suffer from feeling really, really hot doing Keto Diet. My face is as red as beetroot in the mornings and throughout the day I get several hot flushes. Any ideas?:explode:

  2. rachelrb85

    Could it be menopause?

  3. Jeanwf

    I have finished now with the menopause as I started when I was 46! Grrrrr. Could it be because I am burning fat?

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If you would like to get hold of my books, one on Physiology and another on Pathophysiology, check out my web site campbellteaching.co.uk Funds from selling books helps to finance distribution of resources to students in poorer countries.

Hyperosmolar Hyperglycaemic State (hss Or Honk)

consider need for central line if co-morbid conditions such as congestive cardiac failure acute major illnesses such as myocardial infarction, cerebrovascular accident or pancreatitis drugs that affect carbohydrate metabolism including glucocorticoids, second-generation antipsychotic agents poor compliance with insulin or oral hypoglycaemic regimen newly recognised Type 2 Diabetes Mellitus patients often have severe intravascular depletion due to prolonged periods of hyperglycaemia resulting in fluid loss from osmotic diuresis. usual fluid deficit is around 4-5 litres. a typical rate of replacement (tempered by co-morbidities such as history of congestive cardiac failure , ischaemic heart disease (IHD) ): once the blood glucose 20mmol/L, (aim is to achieve this gradually over the 1st 24 hrs), commence 8 hourly 1L 5% Dextrose in addition to Normal Saline until re-hydration is complete. if BGL < 15mmol/L, cease insulin infusion and contact endocrine unit if BGL 15mmol/L and falling by 4mmol/hr, reduce insulin infusion rate by 1 unit/hr if BGL 15mmol/L and not falling by 2mmol/hr, increase insulin infusion rate by 1 unit/hr if intravenous access is temporarily not possible, subcutane Continue reading >>

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  1. Luminosity

    Does Ribose Cause Kidney Failure, Ketosis, Acidosis, and Proteinuria?

    I've run across online accounts of young people who developed health problems after taking Ribose. They were on low carb diets at the time. Symptoms include proteinuria (protein in the urine), foamy urine, and swelling of the abdominal area.
    Here's one:
    http://www.longecity...uria-prolonged-
    Here's another:
    http://www.longecity...330#entry509330
    Here's another that I think is the same poster posting a while ago on medhelp.org:
    http://www.medhelp.o...p-/show/1636827
    I find the response by a poster called Red Star interesting.
    "According to the FDA, some studies have found D-ribose supplementation causes an increase in uric acid. High uric aclevels (hyperuricemia) may not cause significant adverse effects in most people however some may develop gout, kidney stones, or kidney failure resulting from high uric acid levels. As kidney function declines and large amounts of proteins are passing into the urine, swelling of the hands, feet, abdomen and face may occur.
    The stages of CKD (Chronic Kidney Disease) are mainly based on measured or estimated GFR (Glomerular Filtration Rate).
    Stage 1 (90+)
    Normal kidney function* but urine findings or structural abnormalities or genetic trait point to kidney disease . . . ."
    *emphasis added
    So the first stage of kidney disease has normal test results. That person eventually spent thousands on Western Medicine without getting a diagnosis or cure.
    I would advise going to an acupuncturist/Chinese herbalist for this problem, as well as following the diet and lifestyle advice provided by Chinese Medicine. I have more information on what that is as well as how to find a good acupuncturist here:
    http://www.longecity...inese-medicine/
    You can also find my thoughts on it on the first two threads above.

  2. fighter

    hI, Luminosity, I am here deteriorating. I just had a recent series of blood work again. Still nothing :( kidney markers are normal except for the still mild protein leakage. My symptoms began as a burning pain in the kidneys, then noticed foamy appearance in the urine.
    It then progressed to muscle wasting, thinning of cartilage.
    Could it be acidosis? But it's not a disease. Should I take sodium bicarbonate? I don't have ketones in the urine but I believe when I took ribose, carnitine, and some other supplements, that's when it began.

  3. Luminosity

    Sorry you've gone through all of that. As I probably wrote on your thread, I felt you should have sought out a good acupuncturist/Chinese herbalist and follow and diet and lifestyle advice from Chinese medicine. Clearly, your kidneys are malfunctioning and Western medicine was unlikely to be able to diagnose or treat you properly.
    I would reread whatever I wrote on your thread and follow the link to my thread on Chinese medicine.
    Taking baking soda is not going to solve your problems. If you read my Chinese Medicine thread and go to a few appointments with a GOOD acupuncturist (and not all of them are) I could review your diet, supplements, lifestyle for anything that might be improved, if you ask. There is no magic supplement that is going to cure you and you have to stop trying to treat the symptoms one by one with exotic or impulsively chosen supplements.
    I wouldn't waste any time, if I were you. This is all contingent on the assumption that all your symptoms are real. The response from your doctors seems to imply that they don't necessarily think that is true. It's very hard for us to know that when we can't even see you or your medical records, etc. Like for instance, you say you are wasting away. What is your weight now and what was it three years ago? What was it a year ago? How tall are you? It would help of you could send pictures to me that show how you are wasting away. Maybe you can send them to me through the messaging system here, not sure.

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DKA and HHS (HHNS) nursing NCLEX lecture review of the treatment, patient signs/symptoms, and management. Diabetic ketoacidosis and hyperosmolar hyperglycemia nonketotic syndrome are two complications that can present in diabetes mellitus. DKA is more common in type 1 diabetics, whereas, HHNS is more common in type 2 diabetics. Patients with diabetic ketoacidosis will present with ketosis and acidosis and signs/symptoms will include hyperglycemia (greater than 300 mg/dL), Kussmaul breathing, fruity (acetone breath), ketones in the urine, and metabolic acidosis. Patients with hyperglycemic hyperosmolar syndrome will NOT have ketosis or acidosis but EXTREME hyperglycemia (greater than 600 mg/dL). In addition, hyperosmolarity will present which will cause major osmotic diuresis and the patient will experience with severe dehydration. Quiz on DKA vs HHNS: http://www.registerednursern.com/dka-... Lecture Notes for this video: http://www.registerednursern.com/dka-... Diabetes NCLEX Review Series: https://www.youtube.com/playlist?list... Video on DKA (detailed lecture): https://www.youtube.com/watch?v=IxrCV... Video on HHNS (detailed lecture): https://www.youtube.com/watch?v=LyExA... Subscribe: http://www.youtube.com/subscription_c... Nursing School Supplies: http://www.registerednursern.com/the-... Nursing Job Search: http://www.registerednursern.com/nurs... Visit our website RegisteredNurseRN.com for free quizzes, nursing care plans, salary information, job search, and much more: http://www.registerednursern.com Check out other Videos: https://www.youtube.com/user/Register... Popular Playlists: "NCLEX Study Strategies": https://www.youtube.com/playlist?list... "Fluid & Electrolytes Made So Easy": https://www.youtube.com/playlist?list... "Nursing Skills Videos": https://www.youtube.com/playlist?list... "Nursing School Study Tips": https://www.youtube.com/playlist?list... "Nursing School Tips & Questions": https://www.youtube.com/playlist?list... "Teaching Tutorials": https://www.youtube.com/playlist?list... "Types of Nursing Specialties": https://www.youtube.com/playlist?list... "Healthcare Salary Information": https://www.youtube.com/playlist?list... "New Nurse Tips": https://www.youtube.com/playlist?list... "Nursing Career Help": https://www.youtube.com/playlist?list... "EKG Teaching Tutorials": https://www.youtube.com/playlist?list... "Personality Types": https://www.youtube.com/playlist?list... "Dosage & Calculations for Nurses": https://www.youtube.com/playlist?list... "Diabetes Health Managment": https://www.youtube.com/playlist?list...

Hyperglycaemic Hyperosmolar Nonketotic Coma (honk)

Hyperglycaemic Hyperosmolar Nonketotic Coma Hyperglycaemic Hyperosmolar Nonketotic Coma (HONK) HONK can occur with very high blood glucose levels Hyperglycaemic hyperosmolar non-ketotic coma is a dangerous condition brought on by very high blood glucose levels in type 2 diabetes (above 33 mmol/L). Hyperglycaemic hyperosmolar non-ketotic coma is a short term complication requiring immediate treatment by a healthcare professional. Before loss of consciousness and coma takes place, patients will display signs of very high blood sugar levels which may include: The condition of very high blood glucose without signs of ketosis may also be known as Hyperosmolar Hyperglycaemic State (HHS). Causes of hyperglycaemic hyperosmolar non-ketotic coma may include undiagnosed type 2 diabetes that has been developing over a number of years. Alternatively, HONK could be brought on by diabetic medication not being taken or very high blood glucose resulting from a period of illness . Treatment for hyperglycaemic hyperosmolar non-ketotic coma will include fluids being given to the patient and insulin administered intravenously. Hyperglycaemic hyperosmolar non-ketotic coma is coma resulting from very hi Continue reading >>

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  1. doesnotvalidate

    Let me start by saying that I’ve read the FAQ. Numerous times.
    I started Keto on August 12th, 2015 – I had previously been eating low carb for about a month, but hadn’t really been focused getting into full ketosis. I started off at around 215lbs.
    Initially I dropped down to around 205, with my lowest being 202. Since then I have jumped back up to 210 and can’t seem to shake it.
    My Keotstix are always Moderate or higher, I check myself a few times a day. It’s been almost a month in “ketosis” and I’m not dropping weight like I feel like should. I’m really frustrated. I don’t cheat, and I’ve been faithful to LCHF for going on a month now.
    On typical day here is what I eat:
    Breakfast:
    * A 20oz. heavy cream latte
    * A mozarella cheesestick or two
    Lunch:
    * Egg Scramble with just meat and cheese (bacon, chorizo, steak)
    Coffee Break:
    * A 20oz. heavy cream latte (sometimes)
    Dinner:
    * A Meat and fibrous green, the last 3 dinners I’ve had were:
    * Steak and Brussel Sprouts cooked in butter
    * Chicken Breast with Garlic Butter and Spinach cooked in butter
    * Steak with Broccoli cooked in butter
    Recently – I’ve not been super hungry, and have on occasion been skipping dinner altogether.
    My numbers look like this:
    * Net Carbs: < 20g / day
    * Fat: 70-150g / day
    * Protein: 60-11g / day
    On a typical day I’ll drink anywhere from 75-100oz of water to stay hydrated. I’m a programmer, so I spend most of my day at my desk, and I have a newborn, and unfortunately don’t have any time for exercise.
    I had been drinking Diet Coke for a while, and maybe a whiskey or three at night. I thought this might be the problem so for the last week I’ve cut out all alcohol and artificial sweeteners. It’s had no effect.
    I’m hoping some of you with more experience living with keto can give me some advice, I feel like I should at the very least losing some weight. It seems far too early for me to plateau. Do I just need to keep waiting? Everyone I know that’s done keto had almost instantaneous results?!? I’m just frustrated – I refuse to give up, but I don’t know what I’m doing wrong.
    Please help. Thank you in advance.
    Generated by Keto Calculator 9.0
    36/M/5'9" | CW 202 | 31% BF | Mostly sedentary
    1330 kcal Goal, a 34% deficit. (710 min, 2016 max)
    25g Carbohydrates
    85g Protein (84g min, 139g max)
    99g Fat (30g min, 175g max)

  2. anbeav

    20 oz heavy cream latte = 2 shots + cream = 18 oz cream = 1800 calories plus another on a coffee break, I might be grateful you're not gaining weight. Reign in the calories, cut the crram, get a food scale and follow your macros
    Weight loss is not instantaneous. You don't get to spend years gaining it and then lose it overnight, it's a marathon not a sprint and you need to maintain a calories deficit

  3. doesnotvalidate

    Thanks for the reply!
    I had started with the heavy cream because a normal latte has so many carbs, and I was told it was a great way to up my fat intake.
    What are a good alternative? Drip coffee + half & half?

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