Hyperosmolar Hyperglycemic State Questions & Answers

Updated: Jan 14, 2019
  • Author: Dipa Avichal, DO; Chief Editor: George T Griffing, MD  more...
  • Print
Questions & Answers

Overview

What is hyperosmolar hyperglycemic state (HHS)?

What are risk factors for the development of hyperosmolar hyperglycemic state (HHS)?

How is hyperosmolar hyperglycemic state (HHS) characterized?

What are the diagnostic features of hyperosmolar hyperglycemic state (HHS)?

What are the treatment options for hyperosmolar hyperglycemic state (HHS)?

What is the metabolic physiology of hyperosmolar hyperglycemic state (HHS)?

What is the role of insulin resistance in the pathogenesis of hyperosmolar hyperglycemic state (HHS)?

What is the role of type 2 diabetes mellitus (DM) in the pathogenesis of hyperosmolar hyperglycemic state (HHS)?

What is the underlying mechanism of hyperosmolar hyperglycemic state (HHS)?

How is glucose affected by hyperosmolar hyperglycemic state (HHS)?

What is the role of hyperosmolarity in the pathogenesis of hyperosmolar hyperglycemic state (HHS)?

Which patients are most likely to develop hyperosmolar hyperglycemic state (HHS)?

What should be assessed prior to treatment of hyperosmolar hyperglycemic state (HHS)?

What is the role of acute illness in the etiology of hyperosmolar hyperglycemic state (HHS)?

Which conditions increase the risk of hyperosmolar hyperglycemic state (HHS)?

Which drugs increase the risk for hyperosmolar hyperglycemic state (HHS)?

What is the etiologic relationship between parenteral nutrition and hyperosmolar hyperglycemic state (HHS)?

Which conditions and illnesses are associated with hyperosmolar hyperglycemic state (HHS)?

What is the prevalence of hyperosmolar hyperglycemic state (HHS) in the US?

How does the incidence of hyperosmolar hyperglycemic state (HHS) vary by age?

How does the incidence of hyperosmolar hyperglycemic state (HHS) vary by sex?

What are the racial predilections of hyperglycemic state (HHS)?

What is the mortality rate for hyperosmolar hyperglycemic state (HHS), and what is the prognosis associated with end-stage renal disease (ESRD)?

How can hyperosmolar hyperglycemic state (HHS) recurrence be prevented?

What is included in the patient education information for patients with hyperosmolar hyperglycemic state (HHS)?

Presentation

What is the prevalence of type2 DM in patients with hyperosmolar hyperglycemic state (HHS)?

What is the onset of symptoms of hyperosmolar hyperglycemic state (HHS)?

What are the clinical presentations of hyperosmolar hyperglycemic state (HHS)?

What are the neurologic symptoms of hyperosmolar hyperglycemic state (HHS)?

What should be the focus of the history in the evaluation of suspected hyperosmolar hyperglycemic state (HHS)?

How is the degree of osmotic diuresis assessed in the evaluation of hyperosmolar hyperglycemic state (HHS)?

What should be included in the physical exam for suspected with hyperosmolar hyperglycemic state (HHS)?

What vital signs findings suggest hyperosmolar hyperglycemic state (HHS)?

Which physical findings suggest hyperosmolar hyperglycemic state (HHS)?

Which physical findings are helpful in identifying underlying diabetes mellitus (DM) in suspected hyperosmolar hyperglycemic state (HHS)?

What is the role of cardiovascular exam in the evaluation of hyperosmolar hyperglycemic state (HHS)?

How is infection differentiated from hyperosmolar hyperglycemic state (HHS)?

Which neurologic findings suggest hyperosmolar hyperglycemic state (HHS)?

What are the common complications of hyperosmolar hyperglycemic state (HHS)?

What is the pathogenesis of cerebral edema in patients with hyperosmolar hyperglycemic state (HHS)?

What are the signs and symptoms of cerebral edema in patients with hyperosmolar hyperglycemic state (HHS)?

What is the likelihood of death from cerebral edema in patients with hyperosmolar hyperglycemic state (HHS)?

What is the pathogenesis of acute respiratory distress syndrome (ARDS) in hyperosmolar hyperglycemic state (HHS)?

What are vascular complications of hyperosmolar hyperglycemic state (HHS)?

DDX

Which conditions should be considered in the differential diagnoses of hyperosmolar hyperglycemic state (HHS)?

What are the differential diagnoses for Hyperosmolar Hyperglycemic State?

Workup

What are the ADA diagnostic criteria for hyperosmolar hyperglycemic state (HHS)?

What are the diagnostic considerations for hyperosmolar hyperglycemic state (HHS) in children?

What is the role of serum glucose measurement in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of hemoglobin A1c measurement in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of serum osmolarity and osmolality measurement in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of electrolyte measurement in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of sodium measurement in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of potassium measurement in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of magnesium measurement in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of bicarbonate concentration and anion gap in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of arterial blood gas (ABG) in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of venous blood gas (VBG) in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of serum ketone measurement in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of renal function studies in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of serum enzyme measurement in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of CBC count in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of urinalysis in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of radiography in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of CT scanning in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What is the role of ECG in the diagnosis of hyperosmolar hyperglycemic state (HHS)?

What are the roles of lumbar puncture and cerebrospinal fluid analysis in the diagnosis of hyperosmolar hyperglycemic state (HHS), and how does HHS affect CHA2DS2-VASc scoring?

Treatment

Where are guidelines for the diagnosis and management of hyperosmolar hyperglycemic state (HHS) found?

What are the main goals in treatment of hyperosmolar hyperglycemic state (HHS)?

What is the initial emergency care for hyperosmolar hyperglycemic state (HHS)?

When is endotracheal intubation indicated in the treatment of hyperosmolar hyperglycemic state (HHS)?

What is the first line of therapy for hyperosmolar hyperglycemic state (HHS)?

What is the role of IV insulin in the treatment of hyperosmolar hyperglycemic state (HHS)?

When is admission to the ICU indicated for the treatment of hyperosmolar hyperglycemic state (HHS)?

How frequently should patients be reevaluated during treatment for hyperosmolar hyperglycemic state (HHS)?

What is the role of heparin and broad-spectrum antibiotics in the treatment of hyperosmolar hyperglycemic state (HHS)?

What is the standard care for dehydration and altered mental status in patients with hyperosmolar hyperglycemic state (HHS)?

What type of airway management is required for patients with hyperosmolar hyperglycemic state (HHS)?

What are the treatment options for metabolic acidosis in hyperosmolar hyperglycemic state (HHS)?

When is IV access indicated in the treatment of hyperosmolar hyperglycemic state (HHS)?

What are the ADA recommendations for fluid resuscitation in the treatment of hyperosmolar hyperglycemic state (HHS)?

What is the role of dextrose in the treatment of hyperosmolar hyperglycemic state (HHS)?

What is the role of insulin therapy in the treatment of hyperosmolar hyperglycemic state (HHS)?

How should IV insulin be administered in the treatment of hyperosmolar hyperglycemic state (HHS)?

What are the ADA recommended steps used for insulin infusion in the treatment of hyperosmolar hyperglycemic state (HHS)?

What is the insulin regimen used following treatment of hyperosmolar hyperglycemic state (HHS)?

When is glycemic control tightened in the treatment of hyperosmolar hyperglycemic state (HHS)?

What is included in intensive management of diabetes following treatment for hyperosmolar hyperglycemic state (HHS)?

How is potassium replaced in the treatment of hyperosmolar hyperglycemic state (HHS)?

When is phosphate, magnesium, and calcium replacement indicated in the treatment of hyperosmolar hyperglycemic state (HHS)?

When is cardiorespiratory monitoring indicated in the management of hyperosmolar hyperglycemic state (HHS)?

When is neurologic monitoring indicated in the treatment of hyperosmolar hyperglycemic state (HHS)?

When is telemetry monitoring indicated in the treatment of hyperosmolar hyperglycemic state (HHS)?

What dietary modifications are needed during treatment for hyperosmolar hyperglycemic state (HHS)?

When are specialist consultations indicated for the management of hyperosmolar hyperglycemic state (HHS)?

What long-term monitoring in needed following treatment for hyperosmolar hyperglycemic state (HHS)?

Medications

Which medications are used in the treatment of hyperosmolar hyperglycemic state (HHS)?

Which medications in the drug class Antidiabetics, Insulins are used in the treatment of Hyperosmolar Hyperglycemic State?

Which medications in the drug class Alkalizing agents are used in the treatment of Hyperosmolar Hyperglycemic State?

Which medications in the drug class Electrolytes Supplements, Parenteral are used in the treatment of Hyperosmolar Hyperglycemic State?