HHS: Hyperglycemia-Hyperosmolar State

what does HHS stand for

hyperglycemic-hyperosmolar state

HHS is…

caused by hyperglycemia and deydration

results from sustained osmotic diuresis and leads to extremely high blood sugars

pt secretes enough insulin to prevent ketosis, but not hyperglycemia

labs

serum glucose: above 600

pH: above 7.4

HCO3: above 20

BUN: elevated

creat: elevated

interventions

monitor for hyprokalemia

monitor for fluid overload

what is the overall goal

rehydrate + restore normal glucose levels within 36-72 hours

assessments

blood sugars

electrolyte balances: every 1-2 hours until stable

dysrhythmias: K

monitor I+Os

s/s

cns changes: confusion → coma

polyuria

polydipsia

dry mucous membranes

fever

fatigue

what should you assess for hourly

s/s cerebral edema: abrupt changes in mental status, abnormal neurological signs, coma

medications

fluid therapy

insulin drip

what solution is preferred and what is the exception

1/2NS; severe hypotension or shock

parameters for fluid therapy

infuse at 1L/hr until central venous pressure begins to rise or until bp + urine output are adequate

what is the rate then reduce to

100-200mL/hr

in the first 12 hrs…

½ total fluid deficit is given, remainder over the next 36 hours

pt education

diabetes management

nutrition education

how to do glucose checks + when to check it

dehydration prevention: at least 2L/day

sick day education

when does coma typically occur

osmolarity reaches above 350 mmol/L

hypokalemia s/s

fatigue/malaise

shallow respirations

hypotension

weak pulse

abd distention

what is the expected outcome for the insulin drip

bg to drop 50-70 mg/dL per hour