HHS Flashcards
HHS stands for
Hyperosmolar Hyperglycemic Syndrome
HHS is…
a life-threatening syndrome
produce enough insulin to keep them out of DKA but not enough to prevent severe hyperglycemia
fewer symptoms lead to higher glucose levels (>600 mg/dL)
more severe neurologic manifestations because of increased serum osmolality
ketones absent or minimal in blood and urine
Who gets HHS
Type 2 diabetics
Precipitating factors for HHS
UTI's Pneumonia Sepsis Acute illness Newly diagnosed type 2 diabetes Impaired thirst sensation and/or inability to replace fluids
Therapy
IV insulin and NaCl infusions
More fluid replacement needed
Monitor serum potassium and replace it as needed
Management
Monitor: IV fluids Insulin therapy Electrolytes Assess: Renal status Cardiopulmonary status LOC
Hypoglycemia
Too much insulin in proportion to glucose in blood
Blood glucose level less than 70 mg/dL
Neuroendocrine hormones released
Autonomic nervous system activated
Common manifestations of hypoglycemia
Shakiness Palpitations Nervousness Diaphoresis Anxiety Hunger Pallor
Altered mental functioning with hypoglycemia
Difficulty speaking Visual disturbances Stupor Confusion Coma
What can untreated hypoglycemia progress to?
LOC
Seizures
Coma
Death
Hypoglycemic unawareness
No warning signs/symptoms until glucose critically low
Related to autonomic neuropathy and lack of counterregulatory hormones
Patients at risk should keep blood glucose levels somewhat higher
What causes hypoglycemia?
Too much insulin or oral hypoglycemic agents
Too little food
Delaying time of eating
Too much exercise
*symptoms can also occur when high glucose level falls too rapidly
Check blood glucose level…
If less than 70 mg/dL, begin treatment
If more than 70 mg/dL, investigate further for cause of signs/symptoms
If monitoring equipment not available, treatment should be initiated
Rule of 15
Treatment Consume 15 g of a simple carb -fruit juice or regular soft drink, 4-6 oz Recheck glucose level in 15 min -repeat if still less than 70 mg/dL Avoid foods with fat -decrease absorption of sugar Avoid overtreatment Give complex CHO after recovery
Treatment in acute care settings
50% dextrose, 20-50 mL, IV push
