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Emergency treatment can correct diabetic hyperosmolar syndrome within hours. Treatment typically includes: 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
How do you treat hyperosmolar hyperglycemic syndrome?
Hyperosmolar hyperglycemic syndrome (HHS) is a serious complication of diabetes mellitus. HHS occurs when a person’s blood glucose (sugar) levels are too high for a long period, leading to severe dehydration (extreme thirst) and confusion. Hyperosmolar hyperglycemic syndrome is also known by many other names, including: Diabetic HHS.
What is hyperosmolar hyperglycemic syndrome?
Hyperosmolar Hyperglycemic State Treatment & Management 1 Approach Considerations. In an emergency situation, whenever possible,... 2 Standard Care for Dehydration and Altered Mental Status. 3 Insulin Therapy for Correction of Hyperglycemia. 4 Electrolyte Replacement. Profound potassium depletion necessitates careful replacement.
How to manage hyperglycemia hyperglycemic state?
Rapid and aggressive intravascular volume replacement is always indicated as the first line of therapy for patients with HHS. Isotonic sodium chloride solution is the fluid of choice for initial treatment because sodium and water must be replaced in these severely dehydrated patients.
What is the first line of therapy for hyperchloremic hyperglycemic state (HHS)?
Do you give insulin for HHNS?
Following recovery many patients presenting with HHNS will not require long term insulin therapy and can be managed effectively with diet or oral agents. Precipitating causes of HHNS must be identified and treated simultaneously with correction of the metabolic abnormalities.
What type of insulin is given for HHS?
Insulin glulisine (Apidra)
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 nurses treat HHS?
Treatment of HHS includes aggressive IV fluids and electrolyte replacement, followed by IV insulin to reduce glucose levels.
Why is dextrose given in HHS?
When the plasma glucose level reaches 300 mg/dl, insulin infusion may be reduced to 0.05-0.1 unit/kg/hour and dextrose can be added to the fluids to keep the glucose level between 250-300 mg/dl until hyperosmolality has resolved and the patient is alert.
What is the difference between DKA and HHNS?
DKA typically evolves within a few hours, whereas HHNS is much slower and occurs over days to weeks, according to 2021 research . The two conditions look similar because of the hyperglycemia component of each condition. Knowing the symptoms of each can help you seek medical care as soon as possible.
How do you manage acute hyperglycemia?
TreatmentGet physical. Regular exercise is often an effective way to control your blood sugar. ... Take your medication as directed. ... Follow your diabetes eating plan. ... Check your blood sugar. ... Adjust your insulin doses to control hyperglycemia.
Is Bicarb low in HHS?
Patients with HHS typically have pH >7.30, bicarbonate level >20 mEq/L, and negative ketone bodies in plasma and urine.
Why is potassium low in HHS?
Both DKA and HHS patients have total body potassium deficits due to osmotic diuresis that require careful repletion. Deficits can be substantial: The average total whole body potassium deficit in DKA is 3 to 5 mEq/kg.
Does normal saline lower blood sugar?
The initial goal of rehydration therapy is repletion of extracellular fluid volume by intravenous administration of isotonic saline to restore intravascular volume; this will decrease counterregulatory hormones and lower blood glucose, which should augment insulin sensitivity.
What electrolyte imbalance should the nurse monitor for in a client diagnosed with hyperosmolar hyperglycemic state HHS )?
Electrolyte shifts are common during correction of hyperosmolar and hyperglycemic states. Monitor electrolyte levels at least every 4 hours, or every 2 hours if needed. Monitor serum sodium and potassium levels closely. If needed, use isotonic and hypotonic saline solutions to adjust the patient's sodium level.
Can patients with HHS eat?
Once the patient's mental status is back to normal and the patient is able to eat, starting an oral diet is indicated. Some HHS patients are unable to eat for several days as a consequence of the comorbidities with which they present.
Does HHS have ketones?
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.
How do you manage acute hyperglycemia?
TreatmentGet physical. Regular exercise is often an effective way to control your blood sugar. ... Take your medication as directed. ... Follow your diabetes eating plan. ... Check your blood sugar. ... Adjust your insulin doses to control hyperglycemia.
What is HHS in type 2 diabetes?
Overview. Diabetic hyperosmolar (hi-pur-oz-MOE-lur) syndrome is a serious condition caused by extremely high blood sugar levels. The condition most commonly occurs in people with type 2 diabetes. It's often triggered by illness or infection.
Which is worse DKA or HHS?
Hyperosmolar hyperglycemic state (HHS) is one of two serious metabolic derangements that occur in patients with diabetes mellitus (DM). It is a life-threatening emergency that, although less common than its counterpart, diabetic ketoacidosis (DKA), has a much higher mortality rate, reaching up to 5-10%.
What is diabetes hyperosmolar syndrome?
Diabetic hyperosmolar syndrome is a medical emergency that you won't have time to prepare for. If you have symptoms of high blood sugar, such as extreme thirst and excessive urination, for a few days, check your blood sugar level and call your doctor for advice.
What to do if you have high blood sugar?
If you feel the symptoms of extreme high blood sugar, call 911 or your local emergency number. Don't try to drive yourself to the hospital. If you're with someone who has diabetes and is acting confused, has one-sided weakness or has passed out, call for medical help right away.
What is HHNS in medical terms?
Hyperglycaemic hyperosmolar non-ketotic syndrome ( HHNS) is a life-threatening complication of uncontrolled diabetes mellitus. This syndrome is characterised by severe hyperglycaemia, a marked increase in serum osmolality, and clinical evidence of dehydration without significant accumulation of ketoa ….
What drugs are associated with osmotic diuresis?
Patients receiving certain drugs including diuretics, corticosteroids, beta-blockers, phenytoin, and diazoxide are at increased risk of developing this syndrome. Patients usually present with a prolonged phase of osmotic diuresis leading to severe depletion of both the intracellular and extracellular fluid volumes.
Is HHNS a complication of diabetes?
HHNS is typically observed in elderly patients with non-insulin-dependent diabetes mellitus, although it may rarely be a complication in younger patients with insulin-dependent diabetes, or those without diabetes following severe burns, parenteral hyperalimentation, peritoneal dialysis, or haemodialysis.
What is the recommended glycemia level for type 2 diabetes?
The recommended level of glycemia for most patients with type 2 diabetes mellitus (DM) is 80-120 mg/dL. This correlates to the hemoglobin A 1c value of 7% recommended by the American Diabetes Association.
What is the insulin regimen for IV?
Once the patient is alert and able to eat, an insulin regimen consisting of short-/rapid-acting insulin and long-acting insulin is needed to wean the patient off of IV insulin therapy and to control glucose levels.
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]).
How often should an endocrinologist monitor blood?
Recheck glucose concentrations every hour. Electrolytes and venous blood gases should be monitored every 2-4 hours or as clinically indicated.
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.
Can potassium be elevated with insulin?
Patients may initially present with normal or elevated potassium levels. With rehydration, the potassium concentration is diluted. With the institution of insulin therapy, potassium is driven into cells, exacerbating hypokalemia. A precipitous drop in the potassium concentration may lead to cardiac arrhythmia.
What is hyperosmolar hyperglycemic state?
Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. It most often occurs in type 2 diabetes, often in the setting of physiologic stress. Hyperosmolar hyperglycemic state is diagnosed by severe hyperglycemia ...
What are the complications of hyperglycemic state?
Complications include coma, seizures, and death. (See also Diabetes Mellitus and Complications of Diabetes Mellitus .) Hyperosmolar hyperglycemic state (previously referred to as hyperglycemic hyperosmolar nonketotic coma [HHNK] and nonketotic hyperosmolar syndrome [NKHS]) is a complication of type 2 diabetes mellitus and has an estimated mortality ...
What is the HHS?
Hyperosmolar Hyperglycemic State (HHS) Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. It most often occurs in type 2 diabetes, often in the setting of physiologic stress.
Why are serum ketones not present in patients with type 2 diabetes?
Serum ketones are not present because the amounts of insulin present in most patients with type 2 diabetes are adequate to suppress ketogenesis.
When to add dextrose?
Dextrose should be added once the glucose level reaches 250 to 300 mg/dL (13.9 to 16.7 mmol/L). The rate of infusion of IV fluids should be adjusted depending on blood pressure, cardiac status, and the balance between fluid input and output.
Is osmolality higher in diabetics?
Because symptoms of acidosis are not present, most patients endure a significantly longer period of osmotic dehydration before presentation, and thus plasma glucose ( > 600 mg/dL [ > 33.3 mmol/L]) and osmolality ( > 320 mOsm/L) are typically much higher than in diabetic ketoacidosis.
