Otterbein University Digital Commons @ Otterbein Nursing Student Class Projects (Formerly MSN) Student Research & Creative Work Summer 2020 Hyperosmolar Hyperglycemic State Justin Momeyer Otterbein University, [email protected] Follow this and additional works at: https://digitalcommons.otterbein.edu/stu_msn Part of the Critical Care Nursing Commons Recommended Citation Momeyer, Justin, "Hyperosmolar Hyperglycemic State" (2020). Nursing Student Class Projects (Formerly MSN). 446. https://digitalcommons.otterbein.edu/stu_msn/446 This Project is brought to you for free and open access by the Student Research & Creative Work at Digital Commons @ Otterbein. It has been accepted for inclusion in Nursing Student Class Projects (Formerly MSN) by an authorized administrator of Digital Commons @ Otterbein. For more information, please contact [email protected]. Hyperosmolar Hyperglycemic State Justin Momeyer, RN, BSN, CCRN Otterbein University, Westerville, Ohio Introduction Case Study Pathophysiology DKA vs HHS Complications Implications for Nursing Care Hyperosmolar hyperglycemic A 24-year-old male is brought - Elevated levels of state (HHS) is a complication of Variables DKA HHS - Acute renal failure - Diagnostic testing with using laboratory blood testing is into the ER for worsening glucagon, diabetes. HHS is an insidious - Rhabdomyolysis imperative in determining pathology and distinguishing difference lethargy and polyuria. Lab values catecholamines, pathologic process that can take Mental Alert Stupor, coma - Coma between DKA and HHS. Nurses should understand what lab tests for the patient revealed cortisol, and growth days to weeks to develop. HHS is - Malignant hyperthermia syndrome are being ordered and ensure timely blood draws for these hypernatremia, hyperglycemia hormone initiate HHS – Status life threatening and requires (children) patients. (1572 mg/dl), elevated creatinine leading to careful management in the - Nurses should understand treatment protocols to ensure proper (5.29 mg/dl), low bicarbonate (13 hyperglycemia, Anion gap > 12 Variable acute care setting. (Stoner, 2017) patient placement within the hospital (almost always in the mmol/L), and elevated anion gap intracellular water intensive care unit). (27 meq/L) indicating anion gap depletion, and osmotic Arterial pH <7.35 >7.30 - Nurses should understand the what kind of treatment is required metabolic acidosis. The patient diuresis (Stoner, 2017). for patients. IV rehydration, electrolyte management, IV insulin also had a serum osmolality of Serum variable > 320 Significance of Pathophysiology administration, and management of complications are the priority Why HHS? 395 mmol/kg indicating - Glycosuria causes loss Osmolality treatment modalities for these patients (Stoner, 2017). If not in hyperosmolar hyperglycemic of water over sodium, - Hyperosmolality in HHS is a contributing place, nurses should be asking questions and advocating for - Diabetes is highly state. which results in Plasma > 250 > 600 factor to decreased LOC (Dhatariya, patients. prevalent disease in the hyperosmolality and glucose United States, and its 2017). - These patients require education at discharge, and nurses should In the ER the patient was dehydration (Stoner, - Lack of ketones in urine or serum is understand the complications of diabetes like DKA and HHS – so complications can lead to aggressively rehydrated with IV 2017). Serum < 20 > 15 distinguishing factor between DKA and that they can be explained to patients. life threatening fluids and electrolyte pathologic processes. bicarbonate HHS (Dhatariya, 2017) replacement. CT scan of the - Insulin levels are high - Acute dehydration worsens kidney - HHS requires early abdomen indicated pancreatitis. enough to prevent identification in order to function, leading to acute renal failure, Conclusions The patient was admitted to the lipolysis/ketogenesis prevent worsening Urine or positive Trace or which can further lead to In conclusion, hyperosmolar hyperglycemic state is a high mortality ICU and treated with the (which would be seen in rhabdomyolysis in some patients patient scenarios. standard protocol for DKA. Once DKA) (Stoner, 2017). serum negative complication of diabetes. The differences between HHS and DKA should - There are similarities (Stoner, 2017). be understood by nurses, especially in intensive care units. Early the patient's acidosis had ketones - Patient with HHS have enough insulin between HHS and DKA, resolved, and the anion gap had recognition of symptoms, diagnosis, and treatment is required to but both require different production to prevent ketosis and closed the patient was Causes and Risk Factors prevent worsening complications. The similarities between HHS and levels of treatment. (Stoner, 2017) worsening levels of metabolic acidosis DKA often are confused, and this poster should help bring to light the transitioned to a normal insulin HHS can be precipitated by: - It is important to compared to DKA (Fayfman, 2017). differences. Complications of HHS can lead to chronic issues for scale. - infections, medications, distinguish the differences - Pathophysiology of DKA vs HHS requires patients and it is crucial for these patients to be managed appropriately undiagnosed diabetes, and similar but different treatment priorities between DKA and HHS so The patient eventually became in the acute care setting. that nurses and providers substance abuse. for each (Fayfman, 2017). anuric and his kidney function - Infections are leading cause can treat appropriately. continued to worsen. The patient (57%) - It is crucial to educate required hemodialysis. Eventually patients on appropriate a CPK level was sent, which (Stoner, 2017) References diabetes management to revealed a level of 129,940 IU/L – avoid complication such indicating rhabdomyolysis. as HHS. - Without appropriate The patient was treated high Signs and Symptoms recognition and rates of IV fluids and continued Dehydration signs: management, HHS can hemodialysis to decrease his CPK - Poor tissue turgor, lead to complications like level. sunken eyeballs, cool hypoglycemia, extremities, cracked/dry hypokalemia, cerebral The patient would end up lips edema, rhabdomyolysis, requiring 2 months of Mental State and even death (Fayfman, intermittent hemodialysis and - Range from lucid to 2019) developed chronic kidney disease disorientation to coma. - Mortality rate ranges stage 2. - Seizures can occur from 10% - 50% (much Other higher than DKA – 1.2%- (Amin, 2018) - polyuria, abdominal Insulin production via the pancreas. Retrieved from 9%) (Stoner, 2017) distension, low grade endocrineweb.com/conditions/type-1-diabetes/what- fever insulin https://www.cartoonstock.com/directory/i/iv. (Stoner, 2017) asp.