Hyperglycemia

Question 1

Initial Considerations..

Answer 1

DKA or HHS

Question 2

DKA S/S

Answer 2

• 250-500 FSBG
• Fast Onset (hours - days)
• Kussmaul respirations
• Fruity-smelling breath
• Tachy, thready pulse
• Orthostatic
• Warm, dry skin & mucous membranes
• 3 P’s
• Nausea/vomiting
• Abdominal pain
• Weight-loss
• Muscle stiffness or aches
• Being very tired
• Diminished LOC

Question 3

DKA HX..

Answer 3

• Younger w/ Type 1
• Physical or emotional trauma
• MI/Stroke
• Pancreatitis
• Pregnancy
• Alcohol or drug misuse, particularly cocaine
• Corticosteroids and some diuretics

Question 4

HHS S/S & HX

Answer 4

> 600 FSBG
- Slow Onset (days - weeks)
- Tachycardia
- Orthostatic
- Shallow/rapid breathing
- ALOC (confusion, delirium, hallucinations)
- Unconsciousness, seizures, coma
- Polydipsia & polyuria
- Blurred vision or loss of vision
- Weakness
- Nausea
- Weight loss
- Fever

HX: Older w/ Type 2

Question 5

TX

Answer 5

• IV access (if authorized)
• Consider EtCO2 to monitor for
  hyperventilation (especially when FSBS ‘HI’ or >600 this is concerning for DKA)
• LR fluid bolus 10 mL/kg
• Cardiac Monitor (12 Lead Ideally)