HYPEROSMOLAR HYPERGLYCEMIC STATE Flashcards
Key Concepts
Marked dehydration & life-threatening electrolyte shifts
Check glucose in AMS and lateralizing signs
Most common trigger is infection
MANAGEMENT
A - stridor
Intubate if GCS 8
B - RR 30, 02 sats 90% on Fi02 30%
C - mottled appearance. VOLUME STATUS. Mucus Membranes. Cap refill. Pulses.
D - CHECK GLUCOSE. GCS, PERRLA & lateralizing signs.
E - Exposure, take down dressings. LOOK FOR SIGNS OF INCITING INFECTION or TRUMA
Monitor
O2 Target to 94%
Vitals
IV Access: 2 large bore IV
Equipment for Airway and ECG - check for life threatening hypo- or hyperkalemia
INITIAL MANAGEMENT
isotonic crystalloid at 30 mL/kg FOLLOWED BY
maintenance fluids at 2 x maintenance (unless the patient has underlying cardiac or renal disease).
Foley in. Monitor Urine Output.
CHECK POTASSIUM LEVEL:
potassium ≥5.5 mmol/L, start insulin infusion.
potassium 3.5 - 5.5 mmol/L, start insulin infusion AND maintenance with KCL
potassium <3.5 mmol/L, replenish potassium before initiating insulin infusion.
Target 3.5 mmol/L
IV insulin infusion 0.05 unit/kg/h.
Maintain potassium levels of at 3.5 mmol/L
INVESTIGATIONS
POC Glucose
CBC
Lytes
Correct Na levels
Extended Lytes
VBG
Lactate
Osmolality
Serum Ketones
UA
Infectious disease workup
MONITOR
Urine Output
fingerstick glucose checks every hour
Serum electrolyte testing every 4 h.
Mental Status Check q hr
If cerebral edema is suspected:
Stop IV fluids.
Elevate the head of the bed.
Perform osmotic diuresis:
Mannitol, 1 g/kg IV over 20-30 min or
Hypertonic sodium chloride 3%2.5-5 mL/kg IV over 15 min
DOCUMENTATION
Serum glucose >33.3
Serum Bicarbonate >18
Serum Osmolality >320 mOsm/kg
Absence of ketonemia or ketonuria
Depressed mental status
