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Hyperosmolar Hyperglycemic State

  • Criteria

    • glc > 600
    • no ketoacid production (vs DKA)
  • Admission orders

    • Admit: ICU
    • Diagnosis: HHS
    • Condition: Critical
    • Vital Signs:
      • BP, pulse, respiration hourly x 6 hours, then q 2 hours x 6 hours, then q 4 hours.
      • Temperature q 4 hours
    • Allergies:
    • Nursing: Strict I/O, capillary glucose hourly, maintain 2 IVs, Daily weights
    • Diet: NPO Until Alert, then Clear Liquids as tolerated, Advance to ADA 1500 kCal Diabetic Diet
    • Activity: Bedrest, Until Mental Status Improves, then Up with Fall Precautions
    • Labs:
      • CBC qd (with differential initially)
      • Chem, Ca, Mg, Phos, q 6 x 24 h
      • serum osmolarity q 12 x 24 h, then qd x 3 days
      • LFTs
      • cardiac enzymes: CK, MB, troponin
      • UA and culture
      • blood cultures x 2
      • ECG
      • CXR
    • IV: NS Plus 20 mEq KCl per Liter at 1000 mL/h for 2 Hours, then Call MD to Reassess
    • Special: nutrition, social work consult
    • Medications:
      • if K > 3.0, give regular insulin 10 units IV bolus, then insulin drip
      • insulin drip at 0.1 units/kg/h
      • KCl 20 mEq IV (in addition to KCl in IVF) prn serum K < 3.6 mg/dL
    • Call house officer: BP < 90 mmHg, Pulse >120 bpm, Temp > 39 C, RR > 30, urine output < 240 mL/8 hours, any change in neurologic status
  • Discharge

    • criteria: ambulating, eating, afebrile, able to self-administer insulin and meds

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