Diabetes Mellitus Complications (HHNS and DKA) N
f9 f9 f9 f9 f9 f9
CLEX
Thef9elderlyf9patientf9withf9typef92f9diabetesf9mellitusf9presentsf9tof9thef9clinicf
9withf9af9feverf9andf9productivef9cough.f9Thef9diagnosisf9off9pneumonia f9isf9m
ade.f9Youf9noticef9tentingf9skin,f9deepf9tonguef9furrows,f9andf9vitalf9signsf9off9
110/80f9mmf9Hg,f9120f9beats/minute,f9andf924f9breaths/minute.f9Whatf9assess
mentf9isf9importantf9forf9youf9tof9obtain?
A.f9Bloodf9glucose
B.f9Orthostaticf9bloodf9pressures
C.f9Urinef9ketones
D.f9Temperaturef9-f9correctf9answer✔ ✔ A.f9Bloodf9glucose
HHSf9isf9typicallyf9seenf9inf9patientsf9withf9typef92f9diabetesf9andf9infection,f9s
uchf9asf9pneumonia.f9Thef9mainf9presentingf9signf9isf9af9glucosef9levelf9abovef9
600f9mg/dL.f9Enoughf9evidencef9off9dehydrationf9alreadyf9existsf9thatf9orthos
taticf9vitalf9signf9assessmentsf9aref9notf9af9priority,f9andf9theyf9aref9oftenf9inacc
uratef9inf9thef9elderlyf9duef9tof9poorf9vascularf9tone.f9Patientsf9withf9HHSf9dof9
notf9havef9elevatedf9ketonef9levels,f9whichf9isf9af9keyf9distinctionf9betweenf9H
HSf9andf9DKA.f9Temperaturef9willf9eventuallyf9bef9takenf9butf9isf9oftenf9blunt
edf9inf9thef9elderlyf9andf9diabetics.f9Anf9infectiousf9diagnosisf9hasf9alreadyf9be
enf9made.f9Thef9glucosef9levelf9forf9appropriatef9fluidf9andf9insulinf9treatment
f9isf9thef9priority.
,Thef9patientf9withf9HHSf9presentedf9withf9af9glucosef9levelf9off9800f9mg/dLf9a
ndf9isf9startedf9onf9IVf9fluidsf9andf9insulin.f9Whatf9actionf9dof9youf9anticipatef9
whenf9thef9patient'sf9glucosef9reachesf9250f9mg/dL?
A.f9Administerf9anf9intravenousf9(IV)f9solutionf9withf95%f9dextrose.
B.f9Administerf9sodiumf9polystyrenef9sulfatef9(Kayexalate).
C.f9Slowf9thef9IVf9infusionf9ratef9tof940f9mL/hour.
D.f9Assessf9cardiacf9monitoringf9forf9peakedf9Tf9waves.f9-f9correctf9answer✔
✔ A.f9Administerf9anf9intravenousf9(IV)f9solutionf9withf95%f9dextrose.
Whenf9bloodf9glucosef9levelsf9fallf9tof9approximatelyf9250f9mg/dL,f9IVf9fluid
sf9containingf9glucosef9aref9administeredf9tof9preventf9hypoglycemia.f9Kaye
xalatef9(forf9cationf9exchange)f9isf9usedf9inf9thef9treatmentf9off9hyperkalemia,f9
whichf9causesf9peakedf9Tf9wavesf9onf9cardiacf9monitoring.f9Inf9HHSf9hypoka
lemiaf9mayf9resultf9fromf9insulinf9movingf9thef9potassiumf9intracellularly.f9Fl
uidf9replacementf9remainsf9af9priority,f9butf9itf9isf9givenf9withf9dextrose.f9Thef9
infusionf9ratef9off940f9mL/hourf9keepsf9thef9veinf9open,f9butf9itf9isf9notf9thef9app
ropriatef9replacementf9rate.
Whatf9isf9af9typicalf9findingf9off9hyperosmolarf9hyperglycemicf9syndromef9(
HHS)?
A.f9Occursf9inf9typef91f9diabetesf9asf9thef9presentingf9symptom
B.f9Slowf9onsetf9resultingf9inf9af9bloodf9glucosef9levelf9greaterf9thanf9600f9mg/
dL
C.f9Ketonef9bodiesf9higherf9thanf94+f9inf9urine
, D.f9Signsf9andf9symptomsf9off9diabetesf9insipidusf9-f9correctf9answer✔ ✔
B.f9Slowf9onsetf9resultingf9inf9af9bloodf9glucosef9levelf9greaterf9thanf9600f9m
g/dL
HHSf9hasf9af9slowerf9onsetf9thanf9diabeticf9ketoacidosis.f9HHSf9isf9oftenf9relat
edf9tof9impairedf9thirstf9sensation,f9inadequatef9fluidf9intake,f9orf9functionalf9i
nabilityf9tof9replacef9fluids.f9Becausef9off9thef9slowerf9onset,f9thef9bloodf9gluc
osef9levelsf9canf9bef9quitef9highf9(moref9thanf9600f9mg/dL)f9beforef9diagnosis.f
9HHSf9isf9seenf9inf9typef92f9diabetics,f9andf9theref9isf9enoughf9circulating f9insul
inf9tof9preventf9ketoacidosis.f9Diabetesf9insipidusf9isf9relatedf9tof9inadequatef9
antidiureticf9hormonef9secretionf9orf9kidneyf9responsef9withf9dilute,f9frequen
tf9urination.f9Itf9isf9notf9relatedf9tof9HHS.
Af9diabeticf9patientf9hasf9af9serumf9glucosef9levelf9off9824f9mg/dLf9(45.7f9mm
ol/L)f9andf9isf9unresponsive.f9Afterf9assessmentf9off9thef9patient,f9youf9suspec
tf9DKAf9ratherf9thanf9HHSf9basedf9onf9thef9findingf9of
A.f9polyuria.
B.f9severef9dehydration.
C.f9rapid,f9deepf9respirations.
D.f9decreasedf9serumf9potassium.f9-f9correctf9answer✔ ✔
C.f9rapid,f9deepf9respirations.
Rapid,f9deepf9respirationsf9aref9Kussmaul'sf9andf9aref9aref9thef9body'sf9attemp
tf9tof9reversef9metabolicf9acidosisf9throughf9exhalationf9off9excessf9carbonf9di
oxide.f9Symptomsf9off9DKAf9includef9manifestationsf9off9dehydration,f9such
f9asf9poorf9skinf9turgor,f9dryf9 mucousf9membranes,f9tachycardia,f9andf9orthost
aticf9hypotension.f9Kussmaulf9respirationsf9(rapid,f9deepf9breathingf9associa
tedf9withf9dyspnea)f9aref9thef9body'sf9attemptf9tof9reversef9metabolicf9acidosisf
f9 f9 f9 f9 f9 f9
CLEX
Thef9elderlyf9patientf9withf9typef92f9diabetesf9mellitusf9presentsf9tof9thef9clinicf
9withf9af9feverf9andf9productivef9cough.f9Thef9diagnosisf9off9pneumonia f9isf9m
ade.f9Youf9noticef9tentingf9skin,f9deepf9tonguef9furrows,f9andf9vitalf9signsf9off9
110/80f9mmf9Hg,f9120f9beats/minute,f9andf924f9breaths/minute.f9Whatf9assess
mentf9isf9importantf9forf9youf9tof9obtain?
A.f9Bloodf9glucose
B.f9Orthostaticf9bloodf9pressures
C.f9Urinef9ketones
D.f9Temperaturef9-f9correctf9answer✔ ✔ A.f9Bloodf9glucose
HHSf9isf9typicallyf9seenf9inf9patientsf9withf9typef92f9diabetesf9andf9infection,f9s
uchf9asf9pneumonia.f9Thef9mainf9presentingf9signf9isf9af9glucosef9levelf9abovef9
600f9mg/dL.f9Enoughf9evidencef9off9dehydrationf9alreadyf9existsf9thatf9orthos
taticf9vitalf9signf9assessmentsf9aref9notf9af9priority,f9andf9theyf9aref9oftenf9inacc
uratef9inf9thef9elderlyf9duef9tof9poorf9vascularf9tone.f9Patientsf9withf9HHSf9dof9
notf9havef9elevatedf9ketonef9levels,f9whichf9isf9af9keyf9distinctionf9betweenf9H
HSf9andf9DKA.f9Temperaturef9willf9eventuallyf9bef9takenf9butf9isf9oftenf9blunt
edf9inf9thef9elderlyf9andf9diabetics.f9Anf9infectiousf9diagnosisf9hasf9alreadyf9be
enf9made.f9Thef9glucosef9levelf9forf9appropriatef9fluidf9andf9insulinf9treatment
f9isf9thef9priority.
,Thef9patientf9withf9HHSf9presentedf9withf9af9glucosef9levelf9off9800f9mg/dLf9a
ndf9isf9startedf9onf9IVf9fluidsf9andf9insulin.f9Whatf9actionf9dof9youf9anticipatef9
whenf9thef9patient'sf9glucosef9reachesf9250f9mg/dL?
A.f9Administerf9anf9intravenousf9(IV)f9solutionf9withf95%f9dextrose.
B.f9Administerf9sodiumf9polystyrenef9sulfatef9(Kayexalate).
C.f9Slowf9thef9IVf9infusionf9ratef9tof940f9mL/hour.
D.f9Assessf9cardiacf9monitoringf9forf9peakedf9Tf9waves.f9-f9correctf9answer✔
✔ A.f9Administerf9anf9intravenousf9(IV)f9solutionf9withf95%f9dextrose.
Whenf9bloodf9glucosef9levelsf9fallf9tof9approximatelyf9250f9mg/dL,f9IVf9fluid
sf9containingf9glucosef9aref9administeredf9tof9preventf9hypoglycemia.f9Kaye
xalatef9(forf9cationf9exchange)f9isf9usedf9inf9thef9treatmentf9off9hyperkalemia,f9
whichf9causesf9peakedf9Tf9wavesf9onf9cardiacf9monitoring.f9Inf9HHSf9hypoka
lemiaf9mayf9resultf9fromf9insulinf9movingf9thef9potassiumf9intracellularly.f9Fl
uidf9replacementf9remainsf9af9priority,f9butf9itf9isf9givenf9withf9dextrose.f9Thef9
infusionf9ratef9off940f9mL/hourf9keepsf9thef9veinf9open,f9butf9itf9isf9notf9thef9app
ropriatef9replacementf9rate.
Whatf9isf9af9typicalf9findingf9off9hyperosmolarf9hyperglycemicf9syndromef9(
HHS)?
A.f9Occursf9inf9typef91f9diabetesf9asf9thef9presentingf9symptom
B.f9Slowf9onsetf9resultingf9inf9af9bloodf9glucosef9levelf9greaterf9thanf9600f9mg/
dL
C.f9Ketonef9bodiesf9higherf9thanf94+f9inf9urine
, D.f9Signsf9andf9symptomsf9off9diabetesf9insipidusf9-f9correctf9answer✔ ✔
B.f9Slowf9onsetf9resultingf9inf9af9bloodf9glucosef9levelf9greaterf9thanf9600f9m
g/dL
HHSf9hasf9af9slowerf9onsetf9thanf9diabeticf9ketoacidosis.f9HHSf9isf9oftenf9relat
edf9tof9impairedf9thirstf9sensation,f9inadequatef9fluidf9intake,f9orf9functionalf9i
nabilityf9tof9replacef9fluids.f9Becausef9off9thef9slowerf9onset,f9thef9bloodf9gluc
osef9levelsf9canf9bef9quitef9highf9(moref9thanf9600f9mg/dL)f9beforef9diagnosis.f
9HHSf9isf9seenf9inf9typef92f9diabetics,f9andf9theref9isf9enoughf9circulating f9insul
inf9tof9preventf9ketoacidosis.f9Diabetesf9insipidusf9isf9relatedf9tof9inadequatef9
antidiureticf9hormonef9secretionf9orf9kidneyf9responsef9withf9dilute,f9frequen
tf9urination.f9Itf9isf9notf9relatedf9tof9HHS.
Af9diabeticf9patientf9hasf9af9serumf9glucosef9levelf9off9824f9mg/dLf9(45.7f9mm
ol/L)f9andf9isf9unresponsive.f9Afterf9assessmentf9off9thef9patient,f9youf9suspec
tf9DKAf9ratherf9thanf9HHSf9basedf9onf9thef9findingf9of
A.f9polyuria.
B.f9severef9dehydration.
C.f9rapid,f9deepf9respirations.
D.f9decreasedf9serumf9potassium.f9-f9correctf9answer✔ ✔
C.f9rapid,f9deepf9respirations.
Rapid,f9deepf9respirationsf9aref9Kussmaul'sf9andf9aref9aref9thef9body'sf9attemp
tf9tof9reversef9metabolicf9acidosisf9throughf9exhalationf9off9excessf9carbonf9di
oxide.f9Symptomsf9off9DKAf9includef9manifestationsf9off9dehydration,f9such
f9asf9poorf9skinf9turgor,f9dryf9 mucousf9membranes,f9tachycardia,f9andf9orthost
aticf9hypotension.f9Kussmaulf9respirationsf9(rapid,f9deepf9breathingf9associa
tedf9withf9dyspnea)f9aref9thef9body'sf9attemptf9tof9reversef9metabolicf9acidosisf
