Essential Facts on the Go: Internal Medicine (25 page)

Add KCL to IVF

VI_1_b
Hyperosmolar Hyperglycemic State

Typically occurs in older adults who become hyperglycemic and have little access to water

As the blood sugar rises it is filtered by the kidney and causes an osmotic diuresis

Occurs in similar setting to DKA

Diagnosis

Serum glucose > 600

Normal pH (can have mild metabolic acidosis)

Urine and blood negative for ketones

Serum Osm > 320 mOsm/L

Treatment

IVFs!!!

Most important treatment

Start with normal saline bolus until hemodynamic stability is achieved

If Na < 145