Question

30 y F presents w 3 day Hx of polydypsia and polyuria. blood glucose is 650 mg/dl, bicarb is 21, pH is 7.35.

Dx?
HHNS (if this was DKA the pH would be much lower)
pathophys?
stress —> increased cortisol —> increased blood glucose
treatment?

Answer 1

The patient's diagnosis is Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS). Its pathophysiology involves stress-induced cortisol release, resulting in increased blood glucose levels. Treatment includes rehydration, insulin therapy, and addressing underlying causes.

Step-by-step explanation:

The diagnosis for this patient is Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS). HHNS is a serious condition that occurs in individuals with type 2 diabetes, typically elderly patients, who experience extreme hyperglycemia. It is characterized by high blood glucose levels (>600 mg/dl), severe dehydration, and altered mental status. The pH in HHNS is usually near normal (in this case, 7.35), distinguishing it from Diabetic Ketoacidosis (DKA) where the pH is lower due to ketoacidosis.

The pathophysiology of HHNS involves a stressor, such as an infection, that causes increased cortisol release. This increased cortisol leads to increased blood glucose levels, as cortisol has anti-insulin effects. In HHNS, the body is still producing insulin, but it is not being effectively utilized, leading to hyperglycemia.

The treatment for HHNS entails rehydration with intravenous fluids, insulin therapy to lower blood glucose levels, and correction of any underlying causes such as infections.