Hyperglycemic hyperosmolar nonketotic syndrome
Definition
It is a life threatening complications of type 2 DM characterised by hyperglycaemia and hyperosmolarity resulting in alterations of the sensorium.
Pathophysiology
The glucose accumulates in the bloodstream because the available insulin is not adequate for the facilitation of its transport into the cells
Hypoglycaemia causes serum hyperosmolarity of 343 mOsm/l with resultant osmotic diuresis and simultaneous profound dehydration
Serum glucose level can be more than 13.9 mmol/l, and the patient may loss about 8-9 liters of body fluid, resulting in severe intracellular dehydration and body cell shrinkage
The blood beckmes thick with pH reading of 7.3 as the ECF( extracellular fluid) decreases, causing the blood flow to be slow, resulting in the increased risk for thrombo- emboli
Nursing care plan
Clinical manifestations
Assessment and common findings
A deteriorating mental status from confusion to coma, seizure, hypovolaemic shock and signs of electrolyte imbalances
A history of anything from days to weeks of polyuria and polydipsia
Possible complications of renal failure qnd myocardial infraction due to decreased renal blood flow and increased cardiac workload respectively
Cerebrovascular accident may result from descresed cerebral blood flow.
Dysrhythmias, arterial thrombosis, multiple organ failure may occur
Diagnosis
High blood glucose of greater than 13.9 mmol/l
Urea and electrolytes which may reveal elevated sodium level and decreased levels of potassium
Serum osmolarity of 343 mOsm/l or higher
Signs of severe dehydration
Nursing management
Maintain fluid administration as prescribed
Strictly monitor intake and output
Monitor heart rate and central venous pressure continuously and report dysrhythmias
Medical management
It focuses on fluid replacement and correction of glucose level and electrolyte abnormalities
Normal saline or 5% dextrose intravenously until the blood glucose drops to <13.9 mmol/l
Fluid administration is given to correct hypovolaemia and hypotension and dextrose solutions are given when blood glucose are less 3.9 mmol/l
Bp must be monitored to assess response to patients to rapid infusion of fluid
Potassium can be added to replacement fluid when the patient's urinary output is adequate
Provide safe nursing care of patient who is restless or in coma
• nurse in a padded cot bed, and with the side rails upat all times
• carry out endotracheal intubation to ensure and maintain adequate airway
•insert an indwelling catheter for accurate measurement of urination
Care for the patient's back and pressure points
•Manage seizures.
Confusion
Seizures
Dehydration
Excessive urination