How would you differentiate between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)?
Correct
Answer: Both of these
... [Show More] conditions will include high levels of blood glucose readings. DKA will exhibit acidosis and urinary ketones while HHS will not. Treatment for each condition is similar with fluid bolus and infusion as well as insulin
bolus and infusion.
Juan is a 42 year old male with complaints of nausea and vomiting for 3 days and has been unable to keep anything down in that time. He has not taken any of his medications due to the nausea and vomiting. Your assessment reveals the following data:
Significant History
Type 2 DM x 4 years, HTN Medications
Lisinopril 10 mg daily Metformin 1000 mg po daily Glipizide 5 mg po daily
Physical Exam
Pale, lethargic gentleman Skin is very dry
VS 94/64 P 112 RR 30 T 99.4 wt 195 pounds ht 5’11 »
Lungs clear bilaterally, rapid respiration CV : RRR, no murmurs or gallops
Abd: soft, non-tender, positive bowel sounds
Labs:
Hb 146 Hct 58% Cr 4.9 Bun 53 Cholesterol 238
Na 126 K 5.6 CL 95 Ca 8.8 Gluc 722 Phosphorus 5.8 Ketone Moderate AST 248 Alk Phos 132
ABG’s
ph 7.01
Pco2 20
Po2 100
Sat 98% (on room air) HCO3 7.5
What are the appropriate initial orders to treat this patient?
Correct
Answer: Admission to the ICU
Normal saline IV bolus to counter the vascular dehydration that has
occurred.
Bolus insulin dose followed by an insulin drip
Electrolyte and blood glucose monitoring frequently fluid resuscitation and insulin administration.
Bicarbonate is typically not administered unless the pH is below 7 Assess the patient for presence of any infection that may have precipitated this event
Juan is a 42 year old male with complaints of nausea and vomiting for 3 days and has been unable to keep anything down in that time. He has not taken any of his medications due to the nausea and vomiting. Your assessment reveals the following data:
Significant History
Type 2 DM x 4 years, HTN Medications
Lisinopril 10 mg daily Metformin 1000 mg po daily Glipizide 5 mg po daily
Physical Exam
Pale, lethargic gentleman Skin is very dry
VS 94/64 P 112 RR 30 T 99.4 wt 195 pounds ht 5’11 »
Lungs clear bilaterally, rapid respiration CV : RRR, no murmurs or gallops
Abd: soft, non-tender, positive bowel sounds
Labs:
Hb 146 Hct 58% Cr 4.9 Bun 53 Cholesterol 238
Na 126 K 5.6 CL 95 Ca 8.8 Gluc 722 Phosphorus 5.8 Ketone Moderate AST 248 Alk Phos 132
ABG’s
ph 7.01
Pco2 20
Po2 100
Sat 98% (on room air) HCO3 7.5
What is the “ corrected” sodium level for the hyperglycemia? What does this mean and how would it impact your treatment plan for this patient?
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