Hyperosmolar Hyperglycemic State
A 72-year-old man was admitted to the MICU with a diagnosis ofhyperglyccmic crisis. He lives alone with his small dog with family living nearby. His daughter dialed 911 after finding her father confused and barely responsive at his home. She reported that he had experienced a cough for the past week. His history is significant for heart failure and type 2 DM. His daily medications include c:am:dilol 6.25 mg orally twice a day, Lipitor 40 mg once a day, lisinopril 20 mg orally once a day, furosemide (Lasix) 20 mg orally twice a day, KCl 20 mEqlday orally, and glipizide 10 mg orally twice a day. On arrival in the ED with the paramedics he is barely responsive and unable to answer any questions. He is maintaining an open airwaywith oxygen supplied via nasal cannula. Signifu:ant .findings on his admission profile are:
Blood glucose climbs higher in HHS than
DKA because:
(A) The pancreas secretes small amounts of insulin in HHS but not in DKA, which raises blood glucose and delays the appearance of symptoms.
(B) Peripheral cellular resistance is protective in DKA but not in HSS which increases blood glucose and symptoms.
(C) Fast acting insulin is contraindicated in DKA but not in
HSS making blood glucose rise more quickly.
(D) The hyperosmolar component of HSS forces glucose into the cells delaying symptoms.
The metabolic acido1is that can occur in
USS is caused by
(A) Ketone acidosis and accumulation of ketone bodies.
(B) Lactic acidosis caused by dehydration and decreased tissue perfusion.
(C) Respiratory acidosis due to decreased respiratory rate and low tidal volume.
(D) Metformin lactic acidosis.
In hypcrglycemic crisis, what is the blood glucose reduction farget in the lint hour using an in1ulin infusion?
(A) Decrease blood glucose by 150 to 200 mg/dL
(B) Normalize blood glucose as quickly as possible
(C) Decrease blood glucose by 50 to 70 mg/dL
(D) Maintain blood glucose by until 2 liters of crystalloid have infused