00:01
Hi!
Welcome to our video
series on diabetes
and severe hyperglycemia.
00:07
Hey, do me a favor.
I want to focus you right from the start.
00:10
So underline or circle,
whatever your style is the word 'severe'.
00:15
Because I want you to know
that's what we're talking about.
00:18
Now I'm going to refer
to them as DKA and HHS,
why?
Because it's going to
be a lot longer video
if every time I'm talking about
DKA, I say,
diabetic ketoacidosis
or when I'm talking about HHS I say,
hyperosmolar hyperglycemic syndrome.
00:37
So we're going to call them
DKA and HHS moving forward.
00:42
Now there's not a
lot on this slide
because I want your
brains clear to focus.
00:47
DKA and HHS do have
some things in common.
00:51
But one happens
predominately in type ones
and one happens predominately in diabetic
clients who have type 2 diabetes.
00:59
So go ahead and Right
in on your notes
above DKA write in type 1,
above HHS write type 2.
01:10
Okay so we started, we know we're
talking about severely high blood sugar.
01:15
We know we have DKA and HHS
and which one happens
in type 1 diabetics
which one happens more
often in type 2 diabetics.
01:24
Now, there are four specific
things I want you to think about.
01:26
So we're just
talking big picture.
01:29
They have four things that both
DKA and HHS have in common.
01:34
I'll explain more about it
later in the video series.
01:36
So don't get really
wrapped up in details.
01:39
I just want you to have this
framework as we're starting out.
01:42
So the first thing
is both DKA and HHS
happen in diabetic patients,
you have that solid because
you've already written in
type 1 and type 2 in your notes.
01:54
Let's look at the second thing.
01:56
DKA and HHS both represent life
threatening medical emergencies.
02:03
That's how high or severely
elevated their blood glucose is.
02:07
So both DKA and HHS
can become life-threatening
medical emergencies.
02:13
The third one might kind
of remind you of chemistry,
but both show increased
serum plasma osmolarity
because they end up
being really dehydrated.
02:24
Keep in mind the normal serum
osmolarity is 275 to 295.
02:30
Now,
it's made this osmotic effect
because of the serum sodium,
the potassium,
the glucose and urea.
02:38
So when we're talking
about serum osmolarity
we're talking about the density how
much of that substance is in your blood
as compared to the
liquid portion.
02:48
Now, the fourth one is extreme
osmotic diuresis and dehydration.
02:53
See number three and
number four go together,
but let me walk through
that list again,
you got to be diabetic
for this to happen,
because diabetic clients have
really high blood glucose is
when they have DKA or HHS.
03:08
When you have an
elevated glucose,
you also have an
increased serum
plasma osmolarity,
good your tracking with me.
03:16
And that's why you end
up with this extreme
osmotic diuresis
and dehydration.
03:22
Why?
That bloodstream is now
full of a ton of glucose.
03:28
That's what's raising
that plasma osmolarity.
03:31
As the osmolarity
numbers are going higher
that means the water
concentration is getting lower
because the body is dumping water
into that intravascular space
like crazy to try to
delete that concentration.
03:44
However, when you put all
that in intravascular space,
the patient is going
to pee it all out
and that's why they
end up so dehydrated.
03:52
So I don't want to go through
this slide too quickly.
03:54
Remember it's important
that you understand
the similarities
between both of these
later on we're going to talk
talk about the differences.
04:01
So they're diabetic,
they have really
high blood sugars,
their serum osmolarity goes up
which leads to extreme
osmotic diuresis
and eventual dehydration.