Chapter 65 - HSS

Question 1

Criteria for HSS

Answer 1

1. Glucose >300
2. Minimal to absent ketones
3. Osmolality >350

Question 2

Pathogenesis is based on these 3 things?

Answer 2

1. Hormonal alterations
2. Reduction of GFR
3. Concurrent disease

Question 3

Which 4 hormones are responsible for HSS?

Answer 3

1. Glucagon
2. Epinephrine
3. Cortisol
4. Growth hormone

Question 4

What is the pathophys behind minimal to no ketones in HSS?

Answer 4

Small amounts of insulin and hepatic glucagon resistance inhibit lipolysis, thereby preventing ketosis

Question 5

What concurrent disease are associated with HSS?

Answer 5

1. Kidney failure
2. CHF
3. Infection
4. Neoplasia
5. Other endocrinopathis
6. Pancreatitis - 1/3 of all HSS patients

Question 6

Fluid deficit

Answer 6

Fluid deficit (mL): body weight (kg) x % dehydration (as decimal) x 1000 (mL/L)

Question 7

Serum osmolality

Answer 7

2(Na) + (BUN/2.8) + (glucose/18)

Question 8

Effective osmolality

Answer 8

2(Na) + (glucose/18)

Question 9

Corrected sodium

Answer 9

Na measured + 1.6([measured glucose-normal glucose]/100)

Question 10

Normal serum osmolality

Answer 10

290-310 mOsm/kg

Question 11

Neurologic signs are reported with a serum osmolality greater than?

Answer 11

340 mOsm/kg

Question 12

What are the 5 idiogenic osmoles?

Answer 12

1. Taurine
2. Glutamine
3. Glycine
4. Sorbital
5. Inositol