DKA vs. HHNS
Med Surg: Endocrine
DKA HHNS
Patho & Causes: Patho & Causes:
TYPE 1–FASTER & YOUNGER TYPE 2–SLOWER & OLDER ―H COMES 2ND HEADACHE &
CONFUSION
FRUITY BREATH
―D COMES 1ST IN ALPHABET‖ IN ALPHABET‖
S–SEPSIS (INFECTION) NCLEX TIP ILLNESS
S–SICKNESS "STOMACH VIRUS & FLU" INFECTIONS
(MOST COMMOM) OLDER AGE HARDER TO FIX
S–STRESS (SURGERY)
NO FRUITY BREATH
S–SKIP INSULIN EASIER FIX
Signs & Symptoms
Signs & Symptoms
ABDOMINAL PAIN
H–HIGHEST SUGAR OVER-600+
D–DRY & HIGH SUGAR 250-500+ NCLEX TIP
NO ABDOMINAL PAIN
H–HIGHER fluid loss & Extreme
K–KETONES & KUSSMAUL RESP. dehydration NCLEX TIP
(DEEP/RAPID/REGULAR RESPIRATIONS H–Head change–LOC, Confusion, Neurological
AND FRUITY BREATH) NCLEX TIP Manifestations
A–ABDOMINAL PAIN N–No ketones No Acid, (NO fruity breath/
A–ACIDOSIS METABOLIC LESS THAN 7.35 ketones)
(NORMAL 7.35—7.45) S–Slower Onset & Stable Potassium (3.5-5.0)
HYPERKALEMIA (ABNORMALLY HIGH K+)
Treatment Treatment
D–Dehydration FIRST! (0.9% normal saline) NCLEX TIP H–Hydration–0.9% NS 1st, then HYPOtonic NCLEX TIP
K–Kill the sugar (SLOWLY) prevent low sugar S–Stabilize Sugars (Insulin)
*Hourly BS checks* ―land the plane slow & smooth‖ CAUTION: Insulin IV = ONLY Regular Insulin
Over 250: IV Regular insulin ONLY (bolus 1st) • IV bolus NCLEX TIP
Below 200 (or ketones resolve): SQ insulin + 1/2 NS • IV titration
with D5W IV • SQ injection & IV
A–Add Potassium K+ (Yes even if norm: 3.5 - 5.0) • SQ only
During IV Insulin NCLEX TIP
IN-sulin = sugar & K+ IN the cell
Common NCLEX Question
Q:Child is nauseous NOT eating—maybe vomiting—do you
still give INSULIN?
HHNS patients die from hypovolemia
A: Yes, we give sick day insulin to prevent DKA...
because glucose is HIGH during times of illness.
Re-Assessment Potassium Pumps Muscles
Blood Glucose Hourly High Potassium (5.0+) Low Potassium (Below 3.5)
Re-Hydration Signs: High Pump Low Pump
• BP stable & Cap Refill (3 sec or less)
Peaked T waves, ST elevation Flat T wave, ST depression, U wave
• Skin color & warm temp (NOT cool/pale)
• 30ml/hr + Urine Output
• Low spec gravity (1.005–1.030)
NOT Apical pulse NOT Lung sounds NOT Pupils
Potassium IV (Normal 3.5 - 5.0)
O2
• First Action = Heart monitor
Never push = DEATH
• 10–20 mg MAX per hour IV!! (IV Pump)
• Site (central) and Slow infusion Normal ST elevation ST Depression
Med Surg: Endocrine
DKA HHNS
Patho & Causes: Patho & Causes:
TYPE 1–FASTER & YOUNGER TYPE 2–SLOWER & OLDER ―H COMES 2ND HEADACHE &
CONFUSION
FRUITY BREATH
―D COMES 1ST IN ALPHABET‖ IN ALPHABET‖
S–SEPSIS (INFECTION) NCLEX TIP ILLNESS
S–SICKNESS "STOMACH VIRUS & FLU" INFECTIONS
(MOST COMMOM) OLDER AGE HARDER TO FIX
S–STRESS (SURGERY)
NO FRUITY BREATH
S–SKIP INSULIN EASIER FIX
Signs & Symptoms
Signs & Symptoms
ABDOMINAL PAIN
H–HIGHEST SUGAR OVER-600+
D–DRY & HIGH SUGAR 250-500+ NCLEX TIP
NO ABDOMINAL PAIN
H–HIGHER fluid loss & Extreme
K–KETONES & KUSSMAUL RESP. dehydration NCLEX TIP
(DEEP/RAPID/REGULAR RESPIRATIONS H–Head change–LOC, Confusion, Neurological
AND FRUITY BREATH) NCLEX TIP Manifestations
A–ABDOMINAL PAIN N–No ketones No Acid, (NO fruity breath/
A–ACIDOSIS METABOLIC LESS THAN 7.35 ketones)
(NORMAL 7.35—7.45) S–Slower Onset & Stable Potassium (3.5-5.0)
HYPERKALEMIA (ABNORMALLY HIGH K+)
Treatment Treatment
D–Dehydration FIRST! (0.9% normal saline) NCLEX TIP H–Hydration–0.9% NS 1st, then HYPOtonic NCLEX TIP
K–Kill the sugar (SLOWLY) prevent low sugar S–Stabilize Sugars (Insulin)
*Hourly BS checks* ―land the plane slow & smooth‖ CAUTION: Insulin IV = ONLY Regular Insulin
Over 250: IV Regular insulin ONLY (bolus 1st) • IV bolus NCLEX TIP
Below 200 (or ketones resolve): SQ insulin + 1/2 NS • IV titration
with D5W IV • SQ injection & IV
A–Add Potassium K+ (Yes even if norm: 3.5 - 5.0) • SQ only
During IV Insulin NCLEX TIP
IN-sulin = sugar & K+ IN the cell
Common NCLEX Question
Q:Child is nauseous NOT eating—maybe vomiting—do you
still give INSULIN?
HHNS patients die from hypovolemia
A: Yes, we give sick day insulin to prevent DKA...
because glucose is HIGH during times of illness.
Re-Assessment Potassium Pumps Muscles
Blood Glucose Hourly High Potassium (5.0+) Low Potassium (Below 3.5)
Re-Hydration Signs: High Pump Low Pump
• BP stable & Cap Refill (3 sec or less)
Peaked T waves, ST elevation Flat T wave, ST depression, U wave
• Skin color & warm temp (NOT cool/pale)
• 30ml/hr + Urine Output
• Low spec gravity (1.005–1.030)
NOT Apical pulse NOT Lung sounds NOT Pupils
Potassium IV (Normal 3.5 - 5.0)
O2
• First Action = Heart monitor
Never push = DEATH
• 10–20 mg MAX per hour IV!! (IV Pump)
• Site (central) and Slow infusion Normal ST elevation ST Depression
