USMLE Step 3 pt. 2 Question and Answer

what is the best initial thing to do in a patient with a hyperosmolar hyperglycemic state - aggressive volume resuscitation - they are generally severely volume depleted then IV insulin *avoid management of hyperkalemia because these guys usually have a total body potassium deficit what can occur in patients with poorly controlled diabetes - hyperosmolar hyperglycemic state (HHS) or DKA describe Hyperosmolar hyperglycemic state (HHS) - -likely in DM T2 -negative serum ketones (which confirms its not DKA) -bicarb is almost normal -dehydrated because osmotic diuresis caused by hyperglycemia -maybe showing mild acute renal failure -increased serum osmolality = neurologic symptoms -hyperkalemic due to relative insulin insufficiency and hyperosmolality - in spite of an overall body potassium deficit caused by increase urinnary excretion what are the clinical features of compartment syndrome - -pain out of proportion to injury -pain increased on passive stretch -rapid tense swelling -paresthesia (early) - "ant crawling or burning sensation"