RRAPID: Hyperosmolar Non-Ketotic Diabetic State

Question 1

Affects type I or II diabetics?

Answer 1

Type II

Question 2

Diagnosis? (3)

Answer 2

Osmolality >320mosmol/kg
Hyperglycaemia >30 mmol/L
Usually no ketones in urine unless vomiting (trace/+)
No severe acidosis (pH >7.3, bicarbonate >15mmol/L)

Question 3

Response (Breathing)?

Answer 3

ABG

CXR

Question 4

Response (Circulation)?

Answer 4

IV access
Bloods: FBC, U&E's, amylase, serum osmolality 
Blood cultures 
Urinanalysis 
ECG
Monitor glucose & K

Question 5

Response (Disability)?

Answer 5

Blood glucose

NG tube if GCS < 8

Question 6

Insulin Mx?

Answer 6

10 units IV or IM

IV insulin infusion

Question 7

Fluid Mx?

Answer 7

• Initially replace with 0.9% NaCl
• Change to 5% dextrose once blood sugar 14/15mmol/L
• Regularly check potassium

Question 8

What drug should be stopped?

Answer 8

Metformin