HHS & DKA

sick day rules

- sugar

- insulin

- carbs

- ketones

sugar

check blood ________ every 2-3 hrs (even more for pregnant women & children)

- sick day rules

insulin

always continue to take your _______ even when you are sick to avoid DKA

- sick day rules

carbs

make sure you take in enough ________ and drink enough fluids

- if glucose is high = sugar free

- if glucose is low = drink ______ containing drinks

- sick day rules

ketones

check your blood or urine ________ levels every 4 hours

- sick day rules

rapid

if ketones are present in urine, take ________ acting insulin

- and drink plenty of water to flush out the ketones

cortisol

infection increases _________ levels which increases blood sugar

- means the pt needs more insulin/oral meds

HHS causes

1. type II diabetes

2. stressful event

3. fight or flight triggered

4. insulin resistance

5. profound hyperglycemia & hyperosmolarity

6. osmotic diuresis

hyperglycemic hyperosmolar syndrome

a complication of type II diabetes due to an infection most commonly (ex: UTI, pneumonia, flu, MI)

- causes severe dehydration

false

true or false:

in HHS, we see acidosis

true

true or false:

in HHS, we do not see ketosis related GI symptoms, so it less likely for the pt to seek early care

GI

DKA has _____ symptoms which can prompt seeking care

slower

HHS has a ______ onset compared to DKA

- it is also less common

270-300

normal osmolality levels

osmotic diuresis

patients with HHS are at risk for this because serum osmolality is so high, the body attempts to eliminate excess glucose through the urine

hypo

a patient with HHS will be at a VERY HIGH risk for ______volemia

HHS manifestations

- extreme dehydration

- supine or orthostatic hypotension

- confusion, stupor, coma

- seizures possible

- transient hemiparesis

- hyporeflexia or areflexia

- possible tachycardia & dysrhythmias

transient hemiparesis

weakness on one side of the body

skin

a sign of dehydration would be poor _____ turgor, or tenting

DKA blood glucose

glucose level > 250

- DKA or HHS

HHS blood glucose

glucose level > 600

- DKA or HHS

DKA pH

decreased pH (acidotic)

- DKA or HHS

HHS pH

normal pH, not acidotic

- DKA or HHS

DKA serum bicarb

decreased serum bicarb

- DKA or HHS

HHS serum bicarb

normal bicarb level

- DKA or HHS

DKA urine & ketones

present ketones

- DKA or HHS

HHS urine & ketones

trace to absent ketones

- DKA or HHS

DKA serum osmolality

variable serum osmolality

- DKA or HHS

HHS serum osmolality

increased, > 320

- DKA or HHS

DKA mental status

alert to drowsy to comatose

- DKA or HHS

HHS mental status

stupor, comatose, potential for seizure

- DKA or HHS

300

hourly serum glucose checks until blood glucose falls to ______, then every 2-4 hours until stable

- DO NOT USE CGM

Normal saline

to rehydrate someone with HHS, what IV solution will you use?

- will be given several liters of isotonic fluid

urine

once _______ output is adequate, some potassium will be added to IVF

D5 (glucose)

some _____ solution will be given after BG is < 250-300 to assure they don't go hypoglycemic

potassium

insulin drives ________ into the cells

- what electrolyte?

3.5

for insulin administration, low continuous rate once K is greater than _______

120

glucose should drop no more than _______mg/dL/hour

HHS treatment monitoring

monitor ECG, electrolytes, BUN, phosphorous, creatinine, glucose every 2-4 hrs until stable

- rehydrate

- insulin administration

NO

do we ever give potassium as an IV push?

sugar !

once _______ ! has dropped, common for D5 1/2 NS @ 150ml/hr to be prescribed

50

discard first _____ mL of insulin in insulin drop

HHS evaluation

1. plasma osmo less than 300

2, glucose less than 250

3. UO greater than .5/mL/kg

4. cognition is at baseline (can take up to 3 days to recover neuro wise)

0.5

we want urine output greater than ____ mL/kg