endocrine and metabolic disorders
Hyperosmolar Hyperglycemic State (HHS)
Diagnosis of Hyperosmolar Hyperglycemic State
Blood glucose level Serum osmolarity Hyperosmolar hyperglycemic state is initially suspected when a markedly elevated glucose level is found in a fingerstick specimen obtained in the course of a workup of altered mental status. If measurements have not already been obtained, urine should be tested for ketones and the following should be measured in a blood sample: Serum electrolytes Bloodureanitrogen (BUN) Creatinine Glucose Ketones Plasma osmolality Serum potassium levels are usually normal, but sodium may be low or high, depending on volume deficits. Hyperglycemia may cause dilutional hyponatremia, so measured serum sodium is corrected by adding 1.6 mEq/L (1.6 mmol/L) for each 100 mg/dL (5.6 mmol/L) elevation of serum glucose over 100 mg/dL (5.6 mmol/L). BUN and serum creatinine levels are markedly increased. 7.3, but occasionally mild Metabolic Acidosis develops due to lactate accumulation. The fluid deficit can exceed 10 L, and acute circulatory collapse is a common cause of death. Widespread thrombosis is a frequent finding on autopsy and in some cases bleeding may occur as a consequence of Disseminated Intravascular Coagulation (DIC) . Other complications include 