Hyperosmolar hyperglycemic syndrome: The Daily PANCE Blueprint

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Hyperosmolar hyperglycemic syndrome: The Daily PANCE Blueprint

A 68-year-old woman with a history of type 2 diabetes mellitus presents to the emergency department with altered mental status. Her family reports that she has been increasingly lethargic over the past week, with decreased fluid intake and missed doses of her diabetes medications. On examination, she is disoriented, tachypneic, and has dry mucous membranes. Laboratory tests reveal a blood glucose level of 900 mg/dL, serum osmolality of 320 mOsm/kg, and negative ketones in the urine. Which of the following is the most appropriate initial management for this patient's condition?

A. Rapid infusion of normal saline
B. Immediate administration of insulin bolus
C. Oral rehydration therapy
D. Subcutaneous insulin administration
E. Intravenous bicarbonate therapy

Answer and topic summary

The answer is A. Rapid infusion of normal saline

Rapid infusion of normal saline is the most appropriate initial management for a patient with Hyperosmolar Hyperglycemic Syndrome (HHS). HHS is characterized by severe hyperglycemia, increased serum osmolality, and profound dehydration WITHOUT significant ketoacidosis. The primary treatment goal is to restore fluid balance and correct dehydration, which can help lower blood glucose levels and improve serum osmolality. Fluid replacement with normal saline is crucial in the initial stages of treatment.

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Covered under ⇒  PANCE Blueprint Endocrinology ⇒ Diabetes Mellitus (PEARLS) ⇒ Hyperosmolar hyperglycemic syndrome