Final study guide: DKA and HHS Flashcards
DKA: what are we doing for this pt(7)
– Intracranial pressure monitoring
– Mannitol
– Elevate the HOB
– Treat fever
– Treat HTN
– Minimize noxious stimuli
– Correct hypercapnia and
hypoxemia
Hyperglycemic Hyperosmolar State HHS: what
absence of ketone formation
HHS: def (6)
glucose, osmolarity, pH, HCO3, Ketosis, LOC
– Hyperglycemia— 600-2000 (average 1100)
– Hyperosmolality (>350) and osmotic diuresis
– Arterial pH > 7.3
– Serum bicarb > 15
– Ketosis is mild or absent
– Changes in LOC
HHS: pt profile (age, preciperatory events (7))
*age: over 50
*Precipitated: – Infection, stroke, MI, trauma, burns, stress of a major illness and medications
DKA specific s/s: (6)
*HA
*N
*extreme fatigue
*kussmaul breathing
*acetone breath
*ABD pain
HHS specific s/s: (6)
*Convulsions
*coma
*PROFOUND dehydration: little salivation, tachy, increased resps, poor skin turgor, HoTN
*PROFOUND weight loss
*paresthesia (abnorm limb sensation), paresis (partial paralysis), plegia (severe paralysis), aphasia (not able to talk right)
*decreased DTR
DKA gulcose
300 – 800 average 600
Glucometers can’t handle
>600
HHS glucose
600 – 2000 average 1100
DKA potassium (3pts)
- Total body depletion
- Normal or elevated
- Insulin therapy increases the transport of K resulting in lower serum K levels
HHS potassium (2 pts)
- Total body depletion
- Low
DKA HCO3 and pH
both low
HHS HCO3 and pH
both normal
DKA serum osmolality
variable
HHS serum osmolality
elevated
DKA urinalysis (UA)
*glucose: positive
*Ketones: elevated
HHS UA
*Glucose: positive
*Ketones: negative
DKA: rehydration (2)
5 – 10% of body weight
Up to 6L of fluid
HHS: rehydration (2)
150 ml/kg of body weight
7 – 10 L of fluid
DKA: isotonic solution (2)
*1-2L for 1st hour and cont till pt is hemodynamically stable
*1/2 NS and D5W: 50/50 mix when BS drops to 200
HHS: isotonic solution (2)
*2 – 4 L over the 1st hour
*6 – 10 L over the 1st 10 hours is typical may change to D5W ½ NS when glucose gets to 300
DKA and HHS: other potential fluids (2)
- ½ NS is used if Na is > 140
- Colloids (albumin) may be needed if the patient continues
hypotensive
DKA: Insulin (5)
*give IV regular insulin bolus
*IV insulin infusion (0.1 u/kg/hr)
*serum glucose should NOT drop more that 50-70mg/dl/hr to avoid low BS
*insulin usually decreased 3-5 u/hr
*when glucose is <250 d/c drip but only 1-2 hr after SQ insulin started
HHS: insulin (6)
*smaller amounts of insulin needed
*give IV regular insulin bolus
*IV insulin infusion (0.1 u/kg/hr)
*serum glucose should NOT drop more that 50-70mg/dl/hr to avoid low BS
*insulin usually decreased 3-5 u/hr
*when glucose is <300 d/c drip but only 1-2 hr after SQ insulin started
DKA: Bicarbonate RN management (3)
*only if pH <6.9
*DC when pH >7
*HCO3 crosses the BBB more slowly than CO2 -> alkalosis -> pushes K into cells -> low K levels
HHS: Bicarbonate
pt not usually acaidotic
DKA specific monitoring (4)
*measuring ketones w/ I&Os hourly
*Fruity acetone odored breath
*ABGs monitored per shift
*BG chems every hour
HHS specific monitoring (4)
*just I&O Q1hr
*ABG Qdaily
*BG chems Q30min-1hr
*electrolytes Q1hr
DKA & HHS: s/s of fluid vol overload (4)
Neck vein engorgement, dyspnea without exertion, elevated CVP, washing machine lung sounds
DKA & HHS: fluid vol overload tx
- Lower IV rate and add O2 if not already on it
s/s of hypoglycemia (3) and tx (2)
- Hypoglycemia—unexpected behavioral changes,
diaphoresis, tremors - Stop insulin and notify MD
DKA: hyperglycemia s/s (3) and tx (1)
Hyperglycemia—Kussmaul resps, dry skin, fruity acetone breath-notify physician
HHS: hyperglycemia s/s (1) and tx (1)
- Change in LOC
- Notify physician
Seizures are a risk for HHS patients
related to
profound osmotic diuresis
and resulting dehydration
