Hyperosmolar Hyperglycemic State Flashcards
1
Q
What is HHS?
A
- metabolic emergency
- uncontrolled hyperglycemia induces hyperosmolar state in the absence of ketoacidosis
2
Q
Who is affected by HHS?
A
- type 2 diabetes
- the elderly suffer from this most
3
Q
HHS Risk Factors
A
- type 2 DM (new onset or undiagnosed)
- elderly: decreased thirst response, possible cognitive impairment
- new meds
- non-compliance with oral agents or insulin
- underlying infx or sepsis
- acute vascular event
4
Q
Clinical Manifestations of HHS
A
- severe volume depletion
- intracellular dehydration
- elevated serum osmolality
- prerenal azotemia/ARF
5
Q
Signs and Sxs of HHS
A
- dehydration
- sodium variable
- high BP
- high serum osmolality
- weight loss, polyuria, polydipsia
- renal insufficiency (elevated BUN)
- possibly lactic acidosis
6
Q
Treatment of HHS
A
- normal saline: be cautious w/ speed of rehydration
- insulin: regular insulin continuous IV infusion
- potassium: deficits may be large and require replacement, but watch renal function
7
Q
Dehydration in DKA vs HHS
A
- present in DKA
- profound in HHS
8
Q
Stupor/Coma in DKA vs HHS
A
- rarely coma in DKA
- common coma in HHS
9
Q
Kussmaul Respirations in DKA vs HHS
A
- present in DKA
- NOT in HHS
10
Q
Glucose in DKA vs HHS
A
- 250-600 in DKA
- 600-1200 in HHS
11
Q
Serum OSM in DKA vs HHS
A
- 300-320 in DKA
- 330-380 in HHS
12
Q
Ketosis in DKA vs HHS
A
++++ in DKA
+/- in HHS
13
Q
Acidosis in DKA vs HHS
A
- pH < 7.3 in DKA
- pH > 7.3 in HHS
14
Q
Bicarb in DKA vs HHS
A
- < 15 in DKA
- normal or slightly low in HHS
15
Q
Serum K+ in DKA vs HHS
A
- normal to high in DKA
- normal in HHS
16
Q
Lactate in DKA vs HHS
A
- elevated in DKA
- ? in HHS
17
Q
BUN in DKA vs HHS
A
- WNL in DKA
- elevated in HHS
