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DIABETES MELLITUS-HHNK

Endocrinology

DIABETES MELLITUS-HHNK

HYPERGLYCEMIC HYPEROSMOLAR STATE
1. This hyperglycemic complication happens in T2DM and is caused by partial insulin deficiency and dehydration.

2. The patient is usually elderly.

3. Exam is consistent with severe dehydration and volume depletion. These patients are not acidotic, so they do not have the fruity breath or Kussmaul respirations.

4. Inx: hyperglycemia and evidence of dehydration/ volume depletion (Na + deficit-noted after correction for the hyperglycemia) and azotemia.

5. Treat HHS similarly to DKA, with IV fluid resuscitation and insulin bolus + infusion.

6. Be sure to adjust the serum sodium for the hyperglycemia to determine if a free water deficit exists, then replace it gradually over the next 24-48 hours. Potassium replacement is usually required.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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