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    Medical Surgical Notes On The Hyperglycemic Hyperosmolar Nonketotic Syndrome

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    Medical Surgical Notes On The Hyperglycemic Hyperosmolar Nonketotic Syndrome

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    hasnainansari7878
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    Medical Surgical Notes on the Hyperglycemic Hyperosmolar Nonketotic Syndrome

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    Medical Surgical Notes On The Hyperglycemic Hyperosmolar Nonketotic Syndrome

    Uploaded by

    hasnainansari7878

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Hyperglycemic Hyperosmolar

    Nonketotic Syndrome

    Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is a serious condition in which hyperglycemia


    and hyperosmolarity predominate with alterations of the sensorium (sense of awareness). Ketosis is
    minimal or absent. Thenbasic biochemical defect is lack of effective insulin (insulin resistance).

    Pathophysiology

    Persistent hyperglycemia causes osmotic diuresis, resulting in water and electrolyte losses. Although
    there is not enough insulin to prevent hyperglycemia, the small amount of insulin present is enough to
    prevent fat breakdown. This condition occurs most frequently in older people (50 to 70 years of age)
    who have no known history of diabetes or who have type 2 diabetes. The acute development of the
    condition can be traced to some precipitating event, such as an acute illness (eg, pneumonia,
    cerebrovascular accident [CVA]), medications (eg, thiazides) that exacerbate hyperglycemia, or
    treatments such as dialysis.,

    Clinical Manifestations

    • History of days to weeks of polyuria with adequate fluid intake

    • Hypotension, tachycardia

    • Profound dehydration (dry mucous membranes, poor skin turgor)

    • Variable neurologic signs (alterations of sensorium, seizures, hemiparesis)

    Assessment and Diagnostic Methods

    • Laboratory tests, including blood glucose, electrolytes, BUN,bCBC count, serum osmolality, and ABGs

    • Clinical picture of severe dehydration

    Medical Management

    The overall treatment of HHNS is similar to that of diabetic ketoacidosis (DKA): fluids, electrolytes, and
    insulin.

    • Start fluid treatment with 0.9% or 0.45% normal saline,ndepending on sodium level and severity of
    volume depletion.

    • Central venous or hemodynamic pressure monitoring may be necessary to guide fluid replacement.

    • Add potassium to replacement fluids when urinary output is adequate; guided by continuous ECG
    monitoring and laboratory determinations of potassium.

    • Insulin is usually given at a continuous low rate to treat hyperglycemia.

    • Dextrose is added to replacement fluids when the glucose level decreases to 250 to 300 mg/dL.

    • Other therapeutic modalities are determined by the underlying illness and results of continuing clinical
    and laboratory evaluation.
    • Treatment is continued until metabolic abnormalities are corrected and neurologic symptoms clear
    (may take 3 to 5 days for neurologic symptoms to resolve).

    Nursing Management

    • Assess vital signs, fluid status, and laboratory values. Fluid status and urine output are closely
    monitored because of, the high risk of renal failure secondary to severe dehydration.

    • Because HHNS tends to occur in older patients, the physiologic changes that occur with aging should
    be considered.

    • Careful assessment of cardiovascular, pulmonary, and renal function throughout the acute and
    recovery phases of HHNS is important.

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