Hyperosmolar hyperglycemic state - Revision history

ClaireLewis at 16:06, 28 September 2019

2019-09-28T16:06:55Z

← Older revision		Revision as of 16:06, 28 September 2019
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	==Clinical Features==		==Clinical Features==
	*Dehydration		*[[Dehydration]]
	**[[Hypotension]]		**[[Hypotension]]
	*[[Seizure]] (15% of patients)		*[[Seizure]] (15% of patients)
	*[[Altered mental status]]		*[[Altered mental status]]
	*Lethargy/coma		*Lethargy/[[coma]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	===Work Up===		===Work Up===
	*~~Chem~~		*Chemistry
	*Serum ~~Osm~~		*Serum osm
	*Lactate		*[[Lactate]]
	*Serum ketones		*Serum ketones
	*CBC		*CBC
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	**Blood cultures		**Blood cultures
	**[[Urinalysis]]/Urine culture		**[[Urinalysis]]/Urine culture
	**LFTs		**[[LFTs]]
	**Lipase		**Lipase
	**[[Troponin]]		**[[Troponin]]
	**[[CXR]]		**[[CXR]]
	**[[ECG]]		**[[ECG]]
	**Head CT		**[[Head CT]]

	===~~Evaluation~~===		===Diagnosis===
	*Glucose >600		*Glucose >600
	*Osm >320		*Osm >320

Rossdonaldson1: Text replacement - "Troponin" to "Troponin"

2019-07-01T20:44:45Z

Text replacement - "*Troponin" to "*Troponin"

← Older revision		Revision as of 20:44, 1 July 2019
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	**LFTs		**LFTs
	**Lipase		**Lipase
	**Troponin		**[[Troponin]]
	**[[CXR]]		**[[CXR]]
	**[[ECG]]		**[[ECG]]

Kxl328: /* Evaluation */

2018-10-23T04:55:59Z

Evaluation

← Older revision		Revision as of 04:55, 23 October 2018
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	==Evaluation==		==Evaluation==
	*Diagnostic criteria:
	**Plasma glucose level >600 mg/dL
	**Increased effective plasma osmolality >320 mOsm/kg in the absence of ketoacidosis
	===Work Up===		===Work Up===
	*Chem		*Chem

Kxl328: /* Evaluation */

2018-10-23T04:55:18Z

Evaluation

← Older revision		Revision as of 04:55, 23 October 2018
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	===Evaluation===		===Evaluation===
	*Glucose >600		*Glucose >600
	*Osm >~~315~~		*Osm >320
	*Bicarb >15		*Bicarb >15
	*pH >7.3		*pH >7.3

Kxl328: /* Evaluation */

2018-10-23T04:54:52Z

Evaluation

← Older revision		Revision as of 04:54, 23 October 2018
Line 35:		Line 35:

	==Evaluation==		==Evaluation==
			*Diagnostic criteria:
			**Plasma glucose level >600 mg/dL
			**Increased effective plasma osmolality >320 mOsm/kg in the absence of ketoacidosis
	===Work Up===		===Work Up===
	*Chem		*Chem

Kxl328: /* Background */

2018-10-23T04:53:29Z

Background

← Older revision		Revision as of 04:53, 23 October 2018
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	*Ketosis usually absent (may be mild)		*Ketosis usually absent (may be mild)
	*Cerebral edema is uncommon complication (case reports)		*Cerebral edema is uncommon complication (case reports)
			*Estimated mortality 10-20%, usually due to underlying precipitant<ref>Pasquel FJ, Umpierrez GE. Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment. Diabetes Care. 2014; 37(11):3124-31.</ref>
			**In contrast to [[DKA]], in which mortality is 1-5%
			**Incidence of HHS < 1% of hospital admissions of patients with diabetes

	===Precipitants===		===Precipitants===

Sabedi: /* Evaluation */

2018-10-22T02:58:00Z

Evaluation

← Older revision		Revision as of 02:58, 22 October 2018
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	*pH >7.3		*pH >7.3
	*Serum ketones negative or mildly positive		*Serum ketones negative or mildly positive
			*Neurologic abnormalities frequently present (coma in 25-50% of cases)

	==Management==		==Management==

Rossdonaldson1: Text replacement - "UA" to "Urinalysis"

2016-10-02T18:07:06Z

Text replacement - "*UA" to "*Urinalysis"

← Older revision		Revision as of 18:07, 2 October 2016
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	*Also consider:		*Also consider:
	**Blood cultures		**Blood cultures
	**UA/Urine culture		**[[Urinalysis]]/Urine culture
	**LFTs		**LFTs
	**Lipase		**Lipase

Rossdonaldson1: Text replacement - "ECG" to "ECG"

2016-09-09T15:59:14Z

Text replacement - "*ECG" to "*ECG"

← Older revision		Revision as of 15:59, 9 September 2016
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	**Troponin		**Troponin
	**[[CXR]]		**[[CXR]]
	**ECG		**[[ECG]]
	**Head CT		**Head CT

Rossdonaldson1: Text replacement - "CXR" to "CXR"

2016-09-09T10:31:15Z

Text replacement - "*CXR" to "*CXR"

← Older revision		Revision as of 10:31, 9 September 2016
Line 44:		Line 44:
	**Lipase		**Lipase
	**Troponin		**Troponin
	**CXR		**[[CXR]]
	**ECG		**ECG
	**Head CT		**Head CT

Hyperosmolar hyperglycemic state - Revision history

ClaireLewis at 16:06, 28 September 2019

Rossdonaldson1: Text replacement - "*Troponin" to "*Troponin"

Kxl328: /* Evaluation */

Kxl328: /* Evaluation */

Kxl328: /* Evaluation */

Kxl328: /* Background */

Sabedi: /* Evaluation */

Rossdonaldson1: Text replacement - "*UA" to "*Urinalysis"

Rossdonaldson1: Text replacement - "*ECG" to "*ECG"

Rossdonaldson1: Text replacement - "*CXR" to "*CXR"

Rossdonaldson1: Text replacement - "Troponin" to "Troponin"

Rossdonaldson1: Text replacement - "UA" to "Urinalysis"

Rossdonaldson1: Text replacement - "ECG" to "ECG"

Rossdonaldson1: Text replacement - "CXR" to "CXR"