Page 226 - Critical Care Notes

4223_Tab08_216-229 29/08/14 8:26 AM Page 220

ENDO

Clinical Presentation
■ Extreme hyperglycemia with serum glucose ≥600 mg/dL
■ Serum hyperosmolarity of ≥320 mOsm/kg
■ Severe dehydration
■ Poor skin turgor, sunken eyes, dry mouth
■ Tachycardia, hypotension
■ Visual changes or disturbances, sensory deficits
■ Polyuria, polydipsia
■ No significant ketoacidosis
■ Hypotension, tachycardia, tachypnea
■ Hypothermia a poor prognostic factor in HHS
■ Fatigue, drowsiness, lethargy, stupor, delirium
■ Neurological changes suggestive of CVA or other neurological conditions
■ Seizures and coma
Diagnostic Tests
■ Serum electrolytes and chemistries including BUN and creatinine
■ CBC
■ Serum and urine osmolarity and ketones
■ Urinalysis
■ Urine, sputum, and blood cultures if infection suspected
■ ECG
■ ABGs to assess acidosis
■ Chest x-ray
■ If neurological symptoms present, head CT
Management
■ Correct fluid and electrolyte imbalances. Administer 500 mL bolus of iso-
tonic (0.9%) NS IV followed by 1–2 L of either 0.9% or 0.45% NS in the first
2 hours. Use 0.45% NS once BP and urine output adequate. Administer all
IV fluids cautiously or at a slower rate if cardiac or renal disease present
and to prevent cerebral edema.
■ Monitor blood glucose levels carefully
■ Insulin infusion as per policy. Blood glucose levels sensitive to insulin
because the patient may still be secreting some insulin.
■ Assess VS, hemodynamic parameters, intake and output.
■ Assess hydration status frequently.

220