Explore
To treat HHS, your doctor will give you intravenous (IV) medications. These include: Fluids to hydrate you. Electrolytes (such as potassium) to balance the minerals in your body. Insulin to control your blood sugar levels.
What is the treatment for HHS?
If you have symptoms of HHS, you should drink plenty of water and call 911 or go to the emergency room immediately. You will receive an IV with fluids and insulin to relieve your symptoms. Can hyperosmolar hyperglycemic syndrome (HHS) be prevented?
What should I do if I have symptoms of HHS?
The main goals in the treatment of hyperosmolar hyperglycemic state (HHS) are as follows: 1 To vigorously rehydrate the patient while maintaining electrolyte homeostasis 2 To correct hyperglycemia 3 To treat underlying diseases 4 To monitor and assist cardiovascular, pulmonary, renal, and central nervous system (CNS) function
What are the goals of treatment for hyperosmolar hyperglycemic state (HHS)?
The outlook for patients who have HHS largely depends on the person’s age, general health and how severe the disease is. Up to 20% of people who have HHS die from the condition. If you’ve had HHS, you will need to work closely with your doctor once you are home from the hospital.
What is the prognosis for patients with HHS?
What is key to the treatment of HHS?
Aggressive fluid resuscitation is key in the treatment of HHS. This is to avoid cardiovascular collapse and to perfuse vital organs. Fluid deficits in adults are large in HHS, being about 9 L on average.
How do nurses treat HHS?
Treatment of HHS includes aggressive IV fluids and electrolyte replacement, followed by IV insulin to reduce glucose levels.
What do you give for HHS?
To treat HHS, your doctor will give you intravenous (IV) medications....These include:Fluids to hydrate you.Electrolytes (such as potassium) to balance the minerals in your body.Insulin to control your blood sugar levels.
How is HHS and DKA treated?
Early diagnosis and management is paramount to improve patient outcomes. The mainstays of treatment in both DKA and HHS are aggressive rehydration, insulin therapy, electrolyte replacement, and discovery and treatment of underlying precipitating events.
How do you treat HSS?
Treatment typically includes:Fluids given through a vein (intravenously) to treat dehydration.Insulin given through a vein (intravenously) to lower your blood sugar levels.Potassium and sometimes sodium phosphate replacement given through a vein (intravenously) to help your cells function correctly.
Does HHS need insulin drip?
indications: who needs an insulin infusion? Not every patient with HHS necessarily requires an insulin infusion. In many patients, volume resuscitation plus subcutaneous insulin will be perfectly adequate to achieve glycemic control.
What happens in HHS?
Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of type 2 diabetes. It involves extremely high blood sugar (glucose) level without the presence of ketones.
What type of insulin is used for HHS?
Insulin glulisine (Apidra)
What does the HHS do?
The mission of the U.S. Department of Health and Human Services (HHS) is to enhance the health and well-being of all Americans, by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services.
Which intervention is indicated to treat a patient with DKA?
Insulin reverses the processes that cause diabetic ketoacidosis. In addition to fluids and electrolytes, you'll receive insulin therapy — usually through a vein.
Why do you need telemetry for HHS?
Patients with HHS may also require telemetry monitoring if cardiac workup suggests a cardiac etiology , such as MI, for HHS.
What medications are given to a coma patient?
Medications for coma patients. Basic medications given to coma patients in the field may include dextrose (50 mL of 50% dextrose in water [D50]).
Is a consultation necessary for HHS?
Generally, no consultation is absolutely required to manage HHS in the ED; however, in occasional cases, consultations may be useful. A consultation with an endocrinologist is suggested for patients with HHS. Consider a consultation with a neurologist for most patients with altered mental status.
What is the primary focus of the Surgeon General?
The Surgeon General’s Priorities. As the Nation’s Doctor, the U.S. Surgeon General is focused on improving the country’s health.
Why is oral health important?
Oral Health is essential to the general health and well-being of all Americans and can be achieved by all. As the Nation's Doctor, the Surgeon General is responsible for communicating the best available science to the American people.
When was the Public Health Report published?
Published since 1878, Public Health Reports issues original research and commentaries in the areas of tobacco control, health disparities, and critical and emerging public health issues. As a Vice Admiral in the U.S. Public Health Service Commissioned Corps, the Surgeon General leads a uniformed service of more than 6,000 highly qualified public ...
Potential Treatments for COVID-19
COVID-19 treatment options are available for patients with mild to moderate symptoms and for hospitalized patients. Your health care provider will recommend the best treatment option for you, based on your symptoms and your health history.
Monoclonal Antibody Treatments
Your body naturally makes antibodies to fight infection. However, your body may not have antibodies designed to recognize a new virus like SARS-CoV-2, the virus that causes COVID-19. Monoclonal antibodies are made in a laboratory and are given to patients directly with an infusion.
Hospital Treatments
There are treatments for hospitalized patients with severe cases of COVID-19 that have been approved or authorized for emergency use by the Food and Drug Administration (FDA).
What are my rights and responsibilities in health care?
What are my health care rights and responsibilities? As a patient, you have certain rights. Some are guaranteed by federal law, such as the right to get a copy of your medical records, and the right to keep them private.
What is the patient bill of rights?
Many states have additional laws protecting patients, and healthcare facilities often have a patient bill of rights. An important patient right is informed consent. This means that if you need a treatment, your health care provider must give you the information you need to make a decision. Many hospitals have patient advocates who can help you ...
What is the HHS mental health program?
HHS provides programs and services based on evidence-based practices to help people manage mental illness. The following is a list of basic services offered by LMHAs and LBHAs. Contact your local LMHA or LBHA for specific service details.
How to ensure people who need services can exercise consumer choice?
Ensure people who need services can exercise consumer choice by helping them decide on their services, service provider and location of services. Ensure the best use of public money to create a network of service providers and determine whether to provide a service or to contract that service to another organization.
What is a patient centered core outcome set?
Can a patient-centered core outcome set be developed for clinical trials of management of Lyme disease? Core outcome sets are an agreed minimum set of outcome domains to be measured and reported in all trials of a particular treatment or condition. They help ensure consistency in outcomes measures across trials and that the outcome measures pertain to matters that patients regard as important.
Who is the speaker of the Borrelia burgdorferi subcommittee?
Invited speaker Monica E. Embers, PhD, provided an overview on human Lyme disease, treatment regimes, and antibiotic efficacy. She also reported findings of her group’s studies in non-human primates (NHP). Led by Co-Chair Wendy Adams, the subcommittee discussed what they had learned from the two presentations. Wendy reminded the group to keep in mind the priorities the subcommittee had identified.
How does B. burgdorferi infect a host?
B. burgdorferi utilizes many mechanisms to infect a mammalian host and then to evade the immune system and establish persistent infection, either in antibiotic-naïve or antibiotic treated hosts. Some B. burgdorferi research has been carried out on cultured bacteria. Culture studies are easier to control for exogenous factors and they are also less expensive. However, the relationship between findings in culture and in mammalian host are unknown, given the considerable changes B. burgdorferi undergoes as it changes its environment, for example when it moves from vertebrate to invertebrate host and vice versa. Several different animal models have contributed substantially to our knowledge of the bacteria’s ability to evade the mammalian immune system and to survive antibiotic treatment. Inhibition of the complement system and suppression of strong inflammatory responses are examples of effective evasion of innate immunity by B. burgdorferi. Strategies for antigenic variation by B. burgdorferi, and the suppression of effective B cell responses contribute to a lack of bacterial clearance by the adaptive immune system as discussed here.
What is the most common sign of B. burgdorferi?
The most common sign of human infection with B. burgdorferi is the erythema migrans (EM) lesion. In a trial that was well-designed to characterize presenting manifestations of Lyme disease, 78% of the 183 subjects who were symptomatic and classified with definite Lyme disease had an EM rash (Steere & Sikand, 2003). However, other sources have reported lower rates of EM rashes ("Lyme Disease," 2017; Schwartz, Hinckley, Mead, Hook, & Kugeler, 2017). EM lesions are typically annular in shape. The majority of EM lesions are solid-colored; in the Lyme vaccine trial, the classic “bulls-eye” pattern, which exhibits central clearing, was present in only 9% (Smith et al., 2002)). In the untreated, the rash will expand in size for days to weeks before clearing. To satisfy the CDC surveillance case criteria for the rash, primary EM lesions must be ≥ 5cm in size (approximately 2 (CSTE, 2017)). Figure 1 highlights the varied appearance of EM lesions. Publicly available information from health care providers as well as scientific literature often incorrectly identifies the “bulls-eye” lesion as synonymous with EM instead of noting that it is a relatively uncommon EM pattern. Such errors are potentially confusing to patients and clinicians. The reasons for different rash presentations in patients are not known. Recent studies in non-human primates, however, showed that despite being infected with an identical strain, only 3 of 10 infected rhesus macaques developed erythema at the site of infection, and only 1 of the 3 could be classified as a bona fide EM lesion. Like humans, the non-human primates used in the studies were genetically heterogeneous (Embers et al., 2017); therefore, human genetic heterogeneity may be a factor in the variable appearance of EM lesions.
Can B. burgdorferi be treated with antibiotics?
burgdorferi persistently infects natural reservoir species and experimental animals. Most patients suffering from acute symptoms of B. burgdorferi infection are unable to clear the infection without antibiotic treatment ( Steere, 1983). However, the prevalence of subclinical infection of B. burgdorferi in humans is unknown. The concept and findings of persistence of B. burgdorferi following antibiotic treatment is highly controversial. “Persisters”, or dormant variants of bacteria that have not succumbed to therapeutic interventions, have been found for many pathogens including Salmonella typhimurium, Pseudomonas spp. and Mycobacterium tuberculosis, explaining chronic infections with those pathogens despite antibiotic therapies (reviewed in (Lewis, 2010). Both in vitro and in vivo evidence has been presented to suggest that B. burgdorferi may develop persister forms following antibiotic therapy that might cause ongoing signs and symptoms of Lyme disease.
Is culture proven treatment failure rare?
Published cases of culture-proven treatment failure have been relatively rare. However, they do exist despite the lack of available culture tests for clinical use. This has been most commonly reported from skin samples (Hunfeld, Ruzic-Sabljic, Norris, Kraiczy, & Strle, 2005; Pfister et al., 1991; Preac-Mursic et al., 1989; Strle, Maraspin, Lotric-Furlan, Ruzic-Sabljic, & Cimperman, 1996; Strle et al., 1993; Weber, Wilske, Preac-Mursic, & Thurmayr, 1993), but also from cerebrospinal fluid (Liegner et al., 1997; Pfister et al., 1991; Preac-Mursic et al., 1989), blood (Oksi et al., 1999; Viljanen et al., 1992), and ligamentous tissue (Haupl et al., 1993). Notable were the reports by Hunfeld (Hunfeld et al., 2005; Hunfeld, Ruzic-Sabljic, Norris, Kraiczy, & Strle, 2006) in which B. burgdorferi was cultured from the site of a prior EM rash in 19 (1.7%) of 1148 skin culture positive antibiotic-treated EM cases. Five of these 19 cases were studied in great depth; none reported a second tick bite, all took their medication as prescribed (amoxicillin for 14 days (1), ceftriaxone for 14 days (1), cefuroxime for 14 days (2), or azithromycin for 6 days (1)). Culture results from four of the five patients revealed the same genospecies before and after treatment, suggesting these were persistent infections rather than reinfections.
Does B. burgdorferi have an innate immune response?
As discussed above, upon its entry into the mammalian host, B. burgdorferi is perceived by the innate immune response. However, tick salivary proteins play a role in suppressing the host immune system as long as the tick vector is attached. Most of the information we have about these processes come from experimental infection in mice. Numerous isogenic gene knockout strains of C57BL/6 mice have been useful in delineating the role of various innate immune pathways in the context of B. burgdorferi infection. B. burgdorferi engenders a strong innate immune response by engaging toll-like receptors (TLR)2, TLR5, TLR7, TLR8, and TLR9 (Cervantes et al., 2011; Cervantes et al., 2013; Dennis et al., 2009; Marre, Petnicki-Ocwieja, DeFrancesco, Darcy, & Hu, 2010; Parthasarathy & Philipp, 2018; Petzke, Brooks, Krupna, Mordue, & Schwartz, 2009; Wooten et al., 2002). All receptors utilize the downstream MyD88 adaptor protein to induce pro-inflammatory cytokines, and in the case of TLR7, TLR8, and TLR9 induction via nucleic acids, they may also induce Type I interferons (IFN) (Cervantes et al., 2011; Cervantes et al., 2013; Petzke et al., 2009).
Test-To-Treat
Manage Your Covid-19 Symptoms at Home
- The main goals in the treatment of hyperosmolar hyperglycemic state (HHS) are as follows: In an emergency situation, whenever possible, contact the receiving facility while en route to ensure preparation for a comatose, dehydrated, or hyperglycemic patient. When appropriate, notify the facility of a possible cerebrovascular accident or myocardial i...
Out-Of-Hospital Treatment Options For Covid-19
Hospital Treatments For Covid-19
Ensuring The Safety and Effectiveness of Treatments
- If you are sick with COVID-19 or think you might have COVID-19, follow these steps to care for yourselfand to help protect other people in your home and community.