Hyperosmolar Hyperglycemic Syndrome

Pathophysiology

Life-threatening syndrome that can occur in a patient with diabetes who is able to produce enough insulin to prevent DKA, but not enough to prevent sever hyperglycemia, osmotic diuresis, and extracellular fluid depletion

Common Causes

UTI

Pneumonia

Spesis

Any acute illness

Newly diagnosed Type 2 Diabetes

Main difference between HHS and DKA is that those with HHS usually have enough circulating insulin so the ketoacidosis does not occur

Lab Values

Blood glucose level greater then 600 mg/dL

Larked increase in serum osmolarity

Ketone bodies are absent or minimal in both blood and urine

Interprofessional Care

Immediate IV administration of insulin and either 0.9% or 0.45% NaCl

Requires large volumes of fluid replacement - should be done slowly and carefully

Monitor to avoid fluid overload during fluid replacement

When blood glucose levels fall to approximately 250 mg/dL, IV fluids containing dextrose are administered to prevent hypoglycemia

Assess vital signs, intake and output, tissue tumor, lab values, and cardiac monitoring

Nursing Management

Administer IV fluids

IV administration of short-acting insulin

Electrolyte replacement

Assessment of mental status

Recording intake and output

Central venous pressure monitoring

Assessment of blood glucose levels

Assessment of blood and urine for ketones

ECG monitoring

Assessment of cardiovascular and respiratory status

Signs and Symptoms

High glucose >600 mg/dL

Polyuria

Polydipsia

Dehydrated: dry mucous membranes

Fever

Fatigue

Mental Status Changes

Coma

Resources: MedSurg Textbook and Saunders Textbook