Treatments for Hyperglycemic Hyperosmolar Nonketotic Syndrome
Treatments for Hyperglycemic Hyperosmolar Nonketotic Syndrome
The list of treatments mentioned in various sources
for Hyperglycemic Hyperosmolar Nonketotic Syndrome
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
- Hospitalization - HHNS can be severe enough to require hospitalization, especially if occurring in a newly diagnosed diabetic.
- Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting. Milder HHNS can be treated mainly by reducing blood sugars using insulin.
- Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration.
- Treat metabolic imbalances - HHNS is a severe condition that can cause other metabolic changes. Hospital care will test and address other chemical imbalances.
- Treat the underlying cause - Once the main symptoms are alleviated, it is important to identify what caused the HHNS, so as to avoid it recurring. A common cause is that the patient is diabetic, but did not know they were.
- See also treatment of diabetes
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Hyperglycemia:
Treatment
(In a Page: Signs and Symptoms)
-
IV fluids
-
Acute treatment includes insulin administration (IV or subcutaneous) or oral hypoglycemic medications
-
Remove offending medications if possible
-
Treat the underlying etiology
-
Acute treatment of diabetic ketoacidosis involves fluid repletion, correction of electrolyte disturbances, insulin administration, and very frequent monitoring of glucose and electrolytes (intensive care admission is often necessary for initial stages of treatment)
-
Long-term management includes regular testing of HbA1C, glucose (home readings), blood pressure, lipid profile, renal function, and regular podiatric and ophthalmology examinations
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» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Hyperglycemia:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Initial management
–Fluid to correct dehydration
–Insulin to correct hyperglycemia and acidosis
–Intravenous therapy required if patient in DKA
-
Long-term management: Goal is to normalize blood glucose and HbA1c to decrease risk of acute and chronic complications
-
Type II diabetes
–Absolute daily insulin requirement
–Monitor blood glucose (metabolic control)
–Attention to dietary intake (carbohydrate counting)
-
Type II diabetes
–Weight management via diet changes and exercise
–Most require medication (insulin and/or metformin)
-
Prognosis
–Chronic hyperglycemia increases long-term risk of microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (atherosclerosis and ischemic heart disease) complications
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Breath with fruity odor:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
When you detect fruity breath odor, check for Kussmaul's respirations and examine the patient's level of consciousness (LOC). Take his vital signs and check skin turgor. Be alert for fruity breath odor that accompanies rapid, deep respirations; stupor; and poor skin turgor. Try to obtain a brief history, noting especially diabetes mellitus, nutritional problems such as anorexia nervosa, and fad diets with little or no carbohydrates. Obtain venous and arterial blood samples for glucose, complete blood count, and electrolyte, acetone, and arterial blood gas (ABG) levels. Also obtain a urine specimen to test for glucose and acetone. Administer I.V. fluids and electrolytes to maintain hydration and electrolyte balance and, in the patient with diabetic ketoacidosis, give regular insulin to reduce blood glucose levels.
If the patient is obtunded, you'll need to insert endotracheal and nasogastric (NG) tubes. Suction as needed. Insert an indwelling urinary catheter, and monitor intake and output. Insert central venous pressure and arterial lines to monitor the patient's fluid status and blood pressure. Place the patient on a cardiac monitor, monitor his vital signs and neurologic status, and draw blood hourly to check glucose, electrolyte, acetone, and ABG levels.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Diabetes mellitus:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Effective treatment normalizes blood glucose and decreases complications using insulin replacement, diet, and exercise. Current forms of insulin replacement include single-dose, mixed-dose, split-mixed dose, and multiple-dose regimens. The multiple-dose regimens may use an insulin pump. Insulin may be rapid acting, intermediate acting, long acting, or a combination of rapid acting and intermediate acting; it may be standard or purified, and it may be derived from beef, pork, or human sources. Purified human insulin is used commonly today. Pancreas transplantation is experimental and requires chronic immunosuppression.
Successful treatment requires an extensive dietary education. The patient’s diet is specifically tailored to include the right amount and combination of foods. Almost all foods may be eaten occasionally. The diet should address dietary prescriptions as well as personal and cultural preferences to improve adherence and control. For the obese patient with type 2 diabetes, weight reduction is a goal. In type 1 diabetes, the calorie allotment may be high, depending on growth stage and activity level.
Type 2 diabetes may require oral antidiabetic drugs to stimulate endogenous insulin production, increase insulin sensitivity at the cellular level, and suppress hepatic gluconeogenesis.
Five types of drugs have been used to treat diabetes. Sulfonylureas stimulate pancreatic insulin release, increase tissue sensitivity to insulin, and require insulin’s presence to work. Meglitinides cause immediate, brief release of insulin and are taken immediately before meals. Biguanides decrease hepatic glucose production and increase tissue sensitivity to insulin. Alpha-glucosidase inhibitors slow the breakdown of glucose and decrease postprandial glucose peaks. The thiazolidinediones enhance the action of insulin; however, insulin must be present for them to work. These drugs also reduce insulin resistance by decreasing hepatic glucose production and increasing glucose uptake. They have also been shown to lower blood pressure in diabetic hypertensive patients. Cholesterol and triglyceride levels may also be reduced.
Treatment of long-term diabetic complications may include transplantation or dialysis for renal failure, photocoagulation for retinopathy, and vascular surgery for large-vessel disease. Meticulous blood glucose control is essential.
Alert Any patient with a wound that has lasted more than 8 weeks and who has tried standard wound care and revascularization without improvement should consider hyperbaric oxygen therapy. This treatment may speed healing by allowing more oxygen to get to the wound and may therefore result in fewer amputations.
Keeping glucose at near-normal levels for 5 years or more reduces both the onset and progression of retinopathy, nephropathy, and neuropathy. In type 2 diabetes, blood pressure control as well as smoking cessation reduces the onset and progression of complications, including cardiovascular disease.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Diabetic ketoacidosis:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
Insulin, I.V. fluids, sodium bicarbonate
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Hyperosmolar hyperglycemic nonketotic syndrome:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
Insulin, I.V. fluids, potassium
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Breath with fruity odor:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
When you detect fruity breath odor, check for Kussmaul’s respirations and examine the patient’s level of consciousness (LOC). Take vital signs and check skin turgor. Be alert for fruity breath odor that accompanies rapid, deep respirations; stupor; and poor skin turgor. Try to obtain a brief history, noting especially diabetes mellitus, nutritional problems such as anorexia nervosa, and fad diets with little or no carbohydrates. Obtain venous and arterial blood samples for complete blood count and glucose, electrolyte, acetone, and arterial blood gas (ABG) levels. Also obtain a urine specimen to test for glucose and acetone. Administer I.V. fluids and electrolytes to maintain hydration and electrolyte balance, and give regular insulin to patients with diabetic ketoacidosis to reduce blood glucose levels.
If the patient is obtunded, you’ll need to insert endotracheal and nasogastric (NG) tubes. Suction as needed. Insert an indwelling urinary catheter, and monitor intake and output. Insert central venous pressure and arterial lines to monitor the patient’s fluid status and blood pressure. Connect the patient to a cardiac monitor, monitor vital signs and neurologic status, and draw blood hourly to check glucose, electrolyte, acetone, and ABG levels.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Diabetes mellitus:
Treatment
(Handbook of Diseases)
Effective treatment for both types of diabetes normalizes blood glucose and decreases complications.
Type 1 diabetes
Treatment includes insulin replacement, diet, and exercise. Current forms of insulin replacement include single-dose, mixed-dose, split-mixed dose, and multiple-dose regimens. The multiple-dose regimens may use an insulin pump.
Human insulin may be rapid-acting (Regular), intermediate-acting (NPH or Lente), long-acting (Ultralente, Lantus), or a combination of rapid-acting and intermediate-acting (70/30, 75/25, or 50/50 of NPH and Regular).
Clinical tip Insulin Lispro or Novalogue may be used in place of Regular insulin. It’s rapid in onset (15 minutes) and makes waiting to eat after injection unnecessary. It has a short duration of action (4 hours), which decreases between-meal and nocturnal hypoglycemia.
Islet cell or pancreas transplantation is available and requires chronic immunosuppression.
Type 2 diabetes
Patients may require oral antidiabetic drugs to stimulate endogenous insulin production, increase insulin sensitivity at the cellular level, suppress hepatic gluconeogenesis, and delay GI absorption of carbohydrates.
UNDER STUDY: Studies have shown that treatment with a lipase inhibitor (such as orlistat) combined with a low-calorie diet significantly decreases the weight of overweight patients with type 2 diabetes. Patients following this therapy also displayed improvements in glycemic control and cardiovascular risk profile; levels of glycosylated hemoglobin, fasting glucose, and postprandial glucose improved significantly.
Both types
Treatment of both types of diabetes requires a diet planned to meet nutritional needs, to control blood glucose levels, and to reach and maintain appropriate body weight.
For the obese patient with type 2 diabetes, weight reduction is a goal. In type 1, the calorie allotment may be high, depending on growth stage and activity level. For success, the diet must be followed consistently and meals eaten at regular times.
UNDER STUDY: Vitamin E is under investigation for its cellular effects that can possibly reduce the risk of macrovascular disease in patients with type 2 diabetes mellitus. The antioxidant effects of vitamin E were supported, and it was found that, in high doses, vitamin E acts as an anti-inflammatory. It’s postulated that heart disease and stroke risk can be decreased because vitamin E reduces plaque formation at the endothelial level. Vitamin E may also have an effect on the metabolic syndrome that causes diabetes mellitus and may prevent the disease from occurring.
Complications
Treatment of long-term diabetic complications may include transplantation or dialysis for renal failure, photocoagulation for retinopathy, and vascular surgery for large-vessel disease. Meticulous blood glucose control is essential.
The Diabetes Control and Complications Trial has proved that intensive insulin therapy that focuses on keeping glucose at near-normal levels for 5 years or more reduces both the onset and progression of retinopathy (up to 63%), nephropathy (up to 54%), and neuropathy (up to 60%).
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Breath odor, fruity:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Monitor fluid status. Perform neurologic and respiratory assessments. Provide emotional support for the patient and his family. Explain tests and treatments clearly. When the patient is more alert and his condition stabilizes, remove the NG tube and start him on an appropriate diet. Switch his insulin from the I.V. to the subcutaneous route.
Patient teaching
Teach the patient and provide appropriate referrals. For example, teach the patient with uncontrolled diabetes mellitus to recognize the signs of hyperglycemia and to wear a medical identification bracelet. Refer the patient with anorexia nervosa to a psychologist or a support group, and recognize the need for possible long-term follow-up.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Breath with fruity odor:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Teach the patient and make referrals appropriately. For example, teach the patient with uncontrolled diabetes mellitus to recognize the signs of hyperglycemia and to wear a medical identification bracelet. Refer the patient with starvation ketoacidosis to a psychologist or a support group, and recognize the need for possible long-term follow-up.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Breath with fruity odor:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Provide emotional support for the patient and his family.
▪ When the patient is more alert and his condition stabilizes, remove the NG tube and start him on an appropriate diet.
▪ Switch his insulin from the I.V. to the subcutaneous route.
Patient teaching
▪ Explain tests and treatments to the patient.
▪ Discuss the signs and symptoms of hyperglycemia and actions to take.
▪ Emphasize the importance of wearing medical identification.
▪ Refer the patient with starvation ketoacidosis to a psychologist or support group.
▪ Teach the patient about the cause of fruity breath odor after a diagnosis is established.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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