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?
fluids + insulin
Na balance?

Answer 1

A 30-year-old female with polydipsia and polyuria and a blood glucose level of 650 mg/dl is likely experiencing Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS). Treatment involves hydration, insulin therapy, and sodium balance correction. HHNS is often precipitated by stress, leading to increased cortisol and blood glucose levels.

Step-by-step explanation:

The patient, a 30-year-old female, presents with symptoms of polydipsia (increased thirst) and polyuria (increased urination). The diagnostic findings of a blood glucose level of 650 mg/dl, serum bicarbonate level of 21, and a pH of 7.35 suggest Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS). In HHNS, blood glucose levels are extremely high, but ketone bodies are not present, or they are at much lower levels than in Diabetic Ketoacidosis (DKA), hence the near-normal pH level. HHNS can occur in the context of stress, which leads to increased cortisol levels contributing to elevated blood glucose.

Treatment for HHNS involves aggressive intravenous fluids to address dehydration and electrolyte imbalances, alongside insulin therapy to reduce blood glucose levels. Additionally, it is vital to monitor and correct the sodium balance because sodium levels can become deranged due to osmotic shifts and fluid treatment.