Professional Documents
Culture Documents
Hendra Zufry
DD/ Encepalopathy?
Causes of Coma
More than half of all cases of coma are due to
metabolic brain dysfunctions.
2. Hyperosmolar Hyperglicemia
State (HHS)
<1% of all diabetes-related
admissions
More common in elderly & Type 2
diabetics
Mortality
Variable 10-50%
Most often due to the precipitating illness
Causes of DKA/HHS
New diagnosis of Diabetes
Infection: Pneumonia, Gastroenteritis,
UTI
Pancreatitis
Acute MI/ACS
Stroke
Trauma
Alcohol/Drugs/Medications
Missed Insulin/Compliance
Evaluation in DKA/HHS
Laboratory
Glucose
Electrolytes
CBC
Serum Ketones
Plasma Osmolality
ABG (?venous pH)
Urinalysis
?Amylase/Lipase
Other
Electrocardiogram
Chest X-Ray
Blood Culture
Urine Culture
Sputum Culture
Treatment of DKA/HHS
Initial Evaluation: ABCs; Exam; Labs;
Causes
Close Monitoring
Fluid Replacement
Insulin Therapy
Electrolyte Replacement
Resolution & Conversion to home
therapies
3. Hypoglycemia
Mild: Adrenergic (BG<70)
(<4mmol)
Hypoglycemia:
Targets/Goals
Unable to recognize &
verbalize lows: >80 mg/dl
(4.5 mmol)
(3.3
mmol)
Hypoglycemia
Prevention Strategies
Consistent Monitoring
Before All Meals & Snacks
Pre/Post Exercise
Bedtime
3 a.m. (occasionally)
Clinical stages of HE
Clinical stages of HE
5. Hyponatremia
Definition:
Commonly defined as a serum sodium concentration
135 meq/L
Hyponatremia represents a relative excess of water in
relation to sodium.
Hyponatremia..
Epidemiology:
Hyponatremia is the most
ocw.jhsph.edu
common
electrolyte disorder
incidence of approximately 1%
prevalence of approximately 2.5%
surgical ward, approximately 4.4%
30% of patients treated in the intensive
care unit
Hyponatremia
Types
Hypovolemic hyponatremia
Euvolemic hyponatremia
Hypervolemic hyponatremia
Hyponatremia
Treatment
four issues must be addressed
Treatment Cont..
next decide what our desired correction rate
should be
Symptomatic
immediate increase in serum Na level by 8 to 10
meq/L in 4 to 6 hours with hypertonic saline is
recommended
acute hyponatremia
more rapid correction may be possible
8 to 10 meq/L in 4 to 8 hours
chronic hyponatremia
slower rates of correction
12 meq/L in 24 hours
Thanks