Hyperosmolar hyperglycemic state medical therapy: Difference between revisions

Jump to navigation Jump to search
Line 61: Line 61:
** Regain of normal mental status
** Regain of normal mental status
** Regain of normal hemodynamic status
** Regain of normal hemodynamic status
{{familytree/start}}
{{familytree | | | | | | | | | B01 | | | | | |B01=HHS}}
{{familytree | | |,|-|-|-|-|-|-|+|-|-|-|-|-|-|.| }}
{{familytree | | C01 | | | | | C02 | | | | | C03 |C01=Fluids|C02=Insulin|C03=Potassium}}
{{familytree | | |!| | | | | | !  | | | | |!| }}
{{familytree | | | | | | |  | | | | | | | |!| | |  E01 | | | | | | | | E02 | | E03 | | | E04 |E01=K < 3.2|E02=K =3.2 - 5.2|E03=k> 5.2|E04=E04}}
{{familytree/end}}
{{Summary= HHS protocol according to American diabetes association}}


==References==
==References==

Revision as of 19:01, 25 September 2017

Hyperosmolar hyperglycemic state Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hyperosmolar hyperglycemic state from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hyperosmolar hyperglycemic state medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Hyperosmolar hyperglycemic state medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Hyperosmolar hyperglycemic state medical therapy

CDC on Hyperosmolar hyperglycemic state medical therapy

Hyperosmolar hyperglycemic state medical therapy in the news

Blogs on Hyperosmolar hyperglycemic state medical therapy

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Hyperosmolar hyperglycemic state medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Medical Therapy

Basic principles

The basic principles of hyperosmolar hyperglycemic state treatment are:

The American Diabetes Association (ADA) recommends the following therapy for hyperosmolar hyperglycemic state:[1][2][3][4]

Fluid therapy

Insulin therapy

Potassium replacement

  • Potassium replacement is started when the levels fall below the upper limit of normal (5.0-5.2 mEq/L).[9]
  • Goal is to maintain serum potassium levels within the normal range of 3.3–5.2 mEq/L.
  • If serum potassium levels are < 3.3 mEq/L; hold the insulin and add 20 - 30 mEq/ hr of potassium to each litre infusion fluids.
  • If serum potassium levels are > 5.2 mEq/L; do not add potassium but check for serum potassium every 2 hours.

Other electrolytes

Vitamins

Identify and treat the precipitating cause

  • Appropriate investigations can be ordered to find out and treat the precipitating cause.
  • Empiric antibiotics can be administered, if there is suspicion of sepsis only after taking the blood cultures.

Criteria for resolution

  • The following criteria must be met for labeling resolution of hyperosmolar hyperglycemic state:




 
 
 
 
 
 
 
 
HHS
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fluids
 
 
 
 
Insulin
 
 
 
 
Potassium
 
 
 
 
 
 
 
 
 
{{{ ! }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ }}}
 
 
 
 
 
 
 
 
 
 
 
K < 3.2
 
 
 
 
 
 
 
K =3.2 - 5.2
 
k> 5.2
 
 
E04

Template:Summary= HHS protocol according to American diabetes association

References

  1. Radhakrishna Pillai M, Balaram P, Bindu S, Hareendran NK, Padmanabhan TK, Nair MK (1989). "Interleukin 2 production in lymphocyte cultures: a rapid test for cancer-associated immunodeficiency in malignant cervical neoplasia". Cancer Lett. 47 (3): 205–10. PMID 2699725.
  2. 2.0 2.1 2.2 "Diabetes Care".
  3. Nyenwe EA, Kitabchi AE (2011). "Evidence-based management of hyperglycemic emergencies in diabetes mellitus". Diabetes Res. Clin. Pract. 94 (3): 340–51. doi:10.1016/j.diabres.2011.09.012. PMID 21978840.
  4. 4.0 4.1 Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). "Hyperglycemic crises in adult patients with diabetes". Diabetes Care. 32 (7): 1335–43. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.
  5. 5.0 5.1 "Diabetic Ketoacidosis: Evaluation and Treatment - American Family Physician".
  6. Kageyama Y, Kawamura J, Ajisawa A, Yamada T, Iikuni K (1988). "A case of pseudohypoparathyroidism type 1 associated with gonadotropin resistance and hypercalcitoninaemia". Jpn. J. Med. 27 (2): 207–10. PMID 3138479.
  7. "Management of Diabetic Ketoacidosis - American Family Physician".
  8. 8.0 8.1 Gosmanov AR, Gosmanova EO, Dillard-Cannon E (2014). "Management of adult diabetic ketoacidosis". Diabetes Metab Syndr Obes. 7: 255–64. doi:10.2147/DMSO.S50516. PMC 4085289. PMID 25061324.
  9. Beigelman PM (1973). "Potassium in severe diabetic ketoacidosis". Am. J. Med. 54 (4): 419–20. PMID 4633105.
  10. Winter RJ, Harris CJ, Phillips LS, Green OC (1979). "Diabetic ketoacidosis. Induction of hypocalcemia and hypomagnesemia by phosphate therapy". Am. J. Med. 67 (5): 897–900. PMID 116547.
  11. Solomon SM, Kirby DF (1990). "The refeeding syndrome: a review". JPEN J Parenter Enteral Nutr. 14 (1): 90–7. doi:10.1177/014860719001400190. PMID 2109122.

Template:WH Template:WS