Unconscious patient – HHS

FRCEM EXAM QuestionsCategory: March 2017Unconscious patient – HHS
FRCEM Intermediate Staff asked 2 years ago
A 69-year-old lady with a history of type 2 diabetes mellitus for which she takes metformin, is brought to AED by ambulance. She has been in bed for the last couple of days with a Flu-like illness. She is drowsy, confused and dehydrated. Her blood resultsare shown below:
PH 7.3 (7.35-7.45)
K+ 4.5 mmol/L (3.5 – 5.3)
Na+ 145 mmol/L (135 – 145)
Urea 25 mmol/L (2.5 – 6.7)
Creatinine 170 mmol/L (50 – 150)
Glucose 32 mmol/L HCO3 16 mmol/l
A.What is your diagnosis? (1 mark)
B.Give (2) things to do immediately? (1 mark)
C.Calculate this patient’s osmolality, showing your workings? (1 mark)

2 Answers
FRCEM Intermediate Staff answered 2 years ago
A.
Hyperglycaemic hyperosmolar state (HHS)

B.
IV Line – Use intravenous (IV) 0.9% sodium chloride solution as the principle fluid to restore circulating volume and reverse dehydration.
consider Low dose IV insulin (0.05 units/kg/hr) only if blood glucose is no longer falling with IV fluids alone OR immediately if there is significant ketonaemia
identify and treat Underlying precipitants

C.
Calculated osmolality = [2 (Na+ K) + Glucose + Urea] = [(2 x (145+4.5) + 32 + 25]= 356mOsm/kg
(normal serum osmolality is 275 – 295 mOsm/kg)

FRCEM Intermediate Staff answered 2 years ago

Calculated osmolarity = 2 Na + Glucose + Urea ( all in mmol/L).

or

Calculated osmolarity = 2 Na + 2 K + Glucose + Urea ( all in mmol/L).

this video might help you

https://youtu.be/VofGdSeafTA?t=84