Let’s now move on to hyperosmolar non ketotic
This condition or state occurs more so in
a type 2 diabetic who is uncontrolled.
Break up the name, hyperosmolarity is being
caused by what?
Uncontrolled type 2 diabetes, that means that
the patient is now suffering from perhaps
most commonly insulin resistance.
So, therefore, there is going to be massive
and pretty exaggerated hyperglycemia.
When such glucose is elevated in your patient
then he or she is in a state of hyperosmolarity.
Next, well, if there is a little bit of insulin
left then understand that beta oxidation is
not going to be as extensive as what you might
find if in a type 1 diabetic, there is no
insulin at all, non ketotic.
Lab characteristics, take a look at what is
normal, normal plasma osmolarity.
Oh, maybe about 275 to 295, 300 is what you
can use for your boards, you should be in
decent shape, but you start getting above
320, obviously this is a hyperosmolar state.
Take a look at your blood glucose, it is 600
resulting in hyperosmolarity and the pH here
could possibly be 7.3.
Do you understand if you have ketosis, how
in the world could the pH be so high.
Non ketotic is what you are paying attention
Signs and symptoms, once again, lot of osmotic
If you have dehydration, fatigue, blurred
vision, polyuria quite a bit, mental status
changes, you are worried about coma for sure
and take a look at the plasma osmolarity,
Common participants here, once again, new
onset quite a bit of infection in terms of
the cause often times being infection resulting
in a very stressful state and perhaps even
going into DKA.
Other severe physiologic stresses including,
well, stroke, myocardial infarction, obstruction.
Management, once again, fluid resuscitation,
insulin, what are you worried about when you
Number one, you are worried about glucose
dropping extensively and number two, you are
worried about potassium and also monitor magnesium,