How To Treat And Prevent Hyperglycemic Hyperosmolar Syndrome

Hyperglycemic hyperosmolar syndrome, also known as hyperosmolar hyperglycemic nonketotic syndrome, nonketotic hyperosmolar syndrome, and diabetic hyperosmolar syndrome, is a severe complication of diabetes. The condition most often affects type 2 diabetes patients and typically develops after an illness or infection. Older patients are particularly at risk, and the condition is characterized by extremely elevated levels of blood glucose. Patients may also experience severe dehydration, vision loss, fever, dry mouth, confusion, and drowsiness. Some patients may lose consciousness, have seizures or hallucinations, or fall into a diabetic coma. If left untreated, hyperglycemic hyperosmolar syndrome can be fatal. The syndrome usually develops slowly over several weeks. A diagnosis can be confirmed with blood tests, and these must show a blood glucose reading of at least six hundred mg/dL. The methods outlined below can help in the treatment and prevention of hyperglycemic hyperosmolar syndrome.

Intravenous Fluids

Intravenous fluids are given to patients with hyperglycemic hyperosmolar syndrome in the emergency room. These fluids are the first line of treatment, and they are given to help decrease blood sugar levels, increase urine output, and correct dehydration. Along with fluids, insulin may be given to help reduce glucose levels. The fluids most often used are balanced crystalloid solutions and normal saline. Normal saline is also known as isotonic saline and sodium 0.9 percent. Normal saline contains sodium and chloride and can improve electrolyte balance while also replacing lost fluids. Depending on the severity of the hyperglycemic hyperosmolar syndrome, patients may need to receive intravenous fluids for several hours or days at the hospital. The fluids can sometimes be given with a single intravenous line, but a second intravenous line may be needed in severe cases.

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Sodium And Potassium Replacement

In addition to intravenous (IV) fluids, sodium and potassium replacement are typically given at the same time. Sodium is normally replaced through the use of standard IV fluids. Patients with hyperglycemic hyperosmolar syndrome generally have very low potassium as well, and it must be carefully replaced. Potassium replacement usually begins after the patient can produce an adequate level of urine output, and most patients are started on potassium replacement at a rate of ten milliequivalents (mEq). The replacement process may take several hours, and patients will be monitored regularly during this time. Nurses will check the patient's blood pressure, blood oxygen levels, urine output, blood glucose readings, and heart rate. Nurses will also ask the patient to report if they develop any chest pain, dizziness, vision changes, thirst, or fatigue.

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