Diagnostic Tests for Hyperglycemic Hyperosmolar Nonketotic Syndrome
Hyperglycemic Hyperosmolar Nonketotic Syndrome: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Hyperglycemic Hyperosmolar Nonketotic Syndrome
includes:
- Blood sugar test - check for very high blood sugars
- Symptom analysis: dehydration - a check of the symptoms, especially those of dehydration, lead to the doctor to suspect either DKA or HHNS.
- Symptoms: nausea/vomiting - If the patient is nauseous or vomiting, DKA is suspected. If not, HHNS is more likely.
- Urine ketone tests - The presence of ketones in the urine can indicate DKA. Lack of ketones probably means HHNS.
- Blood ketone tests - Blood tests to analyze ketones and acidity in the blood can help confirm DKA versus HHNS.
- See also tests for diabetes
Hyperglycemic Hyperosmolar Nonketotic Syndrome Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Hyperglycemic Hyperosmolar Nonketotic Syndrome:
- High Cholesterol: Home Testing:
- High Blood Pressure: Home Testing
- Heart Health: Home Testing:
- Thyroid: Home Testing:
- Diet & Weight Loss: Home Testing:
- Adrenal Gland Health: Home Testing:
- Kidney Health: Home Testing:
- Diabetes: Related Home Testing:
Hyperglycemic Hyperosmolar Nonketotic Syndrome Diagnosis: Book Excerpts
Diagnostic Tests for Hyperglycemic Hyperosmolar Nonketotic Syndrome: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Hyperglycemic Hyperosmolar Nonketotic Syndrome.
HYPERGLYCEMIA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Further workup may include a CBC, urinalysis, chemistry panel, glucose tolerance test, plasma cortisol, free T
4
, TSH, plasma and urine catecholamines, skull x-ray,
vanillylmandelic acid (VMA)
, and endocrinology consult.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Breath with fruity odor:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient isn't in severe distress, obtain a thorough history. Ask about the onset and duration of fruity breath odor. Find out about changes in breathing pattern. Ask about increased thirst, frequent urination, weight loss, fatigue, and abdominal pain. Ask the female patient if she has had candidal vaginitis or vaginal secretions with itching. If the patient has a history of diabetes mellitus, ask about stress, infections, and noncompliance with therapy — the most common causes of ketoacidosis in known diabetics. If the patient is suspected of having anorexia nervosa, obtain a dietary and weight history.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Breath with fruity odor:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient isn’t in severe distress, obtain a thorough history. Ask about the onset and duration of fruity breath odor. Also ask about any changes in breathing pattern, increased thirst, frequent urination, weight loss, fatigue, and abdominal pain. Ask the female patient if she has had candidal vaginitis or vaginal secretions with itching. If the patient has a history of diabetes mellitus, ask about stress, infections, and noncompliance with therapy—the most common causes of ketoacidosis in known diabetics. If the patient is suspected of having anorexia nervosa, obtain a dietary and weight history.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Diabetes Mellitus:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
Patients often present with similar physical findings in both type 1 and type 2 DM, owing to hyperglycemia. In the young child, failure to grow and gain weight can occur with type 1 DM. The child may be ill appearing, lethargic, and often have signs of dehydration (tachypnea, tachycardia, and low blood pressure). Ketone production will produce a fruity odor on the patient’s breath. The patient with type 2 DM tends to be obese (especially upper body obesity) and may appear fatigued and have muscle weakness or decreased vision. The neurologic examination may reveal painful feet and numbness. Monilial infections may be found in the vagina and pubic areas.
Testing
A. Type 1 diabetes. Not all children with hyperglycemia have diabetes. Some children with a severe illness (e.g., severe dehydration from diarrhea or asthma treated with corticosteroids) may have elevated serum glucose and ketosis. If the diagnosis is uncertain, a low serum insulin level along with hyperglycemia supports the diagnosis of DM and excludes all other diagnoses. Elevated glycosylated hemoglobin provides a strong circumstantial case for the diagnosis of DM, but it is not used alone for the diagnosis. Performing a glucose tolerance test is rarely necessary. However, it is imperative to obtain insulin levels along with the blood glucose values when it is performed.
B. Type 2 diabetes. The American Diabetes Association (ADA) diagnostic criteria for type 2 DM are either (a) symptoms of diabetes and a casual plasma glucose level of 200 mg/dl or greater, (b) a fasting plasma glucose level of 126 mg/dl or greater, or (c) a plasma glucose level of 200 mg/dl or greater 2 hours after an oral glucose load (75 g). A “casual” plasma blood glucose level is obtained at any time of the day without regard to the time of the last meal, and a “fasting” level is obtained after a fast of at least 8 hours. If the only criterion is hyperglycemia, confirmation should be made on a different day (1).
Diagnostic assessment
The presence of polyuria, polydipsia, polyphagia, and weight loss along with hyperglycemia and ketosis are sufficient to establish the diagnosis of type 1 DM. This provides an ample basis for beginning insulin therapy. Hyperglycemia can also occur during a severe illness. Therefore, the diagnosis of type 1 DM is not always clear. Low insulin levels may be needed to make the diagnosis. The key to the diagnosis of type 2 DM is the detection of hyperglycemia. Patients with symptoms of diabetes should have testing according to the ADA recommendations. Once the diagnosis is made, formulate a treatment program with the patient.
References
1. American Diabetes Association. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997;20:1183–1197.
2. National Diabetes Data Group. Diabetes in America, 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, 1995. NIH publication 1468-1995.
3. Baker JR. Autoimmune endocrine disease. JAMA 1997;278:1931–1937.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Breath with fruity odor:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin by taking your patient’s vital signs. Then proceed with a complete physical assessment.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Breath with fruity odor:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient isn't in severe distress, obtain a thorough history. Ask about the onset and duration of fruity breath odor. Find out about changes in breathing pattern. Ask about increased thirst, frequent urination, weight loss, fatigue, and abdominal pain. Ask the female patient if she has had candidal vaginitis or vaginal secretions with itching. If the patient has a history of diabetes mellitus, ask about stress, infections, and noncompliance with therapy—the most common causes of ketoacidosis in known diabetics. If the patient is suspected of having anorexia nervosa, obtain a dietary and weight history.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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