Treatment of hyperosmolar hyperglycemic state in adults

HHS: hyperosmolar hyperglycemic state; IV: intravenous; NaCl: sodium chloride; K: potassium; Na: sodium; BUN: blood urea nitrogen; SC: subcutaneous.

* After history and physical exam, obtain capillary glucose and serum or urine ketones (nitroprusside method). Begin 1 liter of 0.9% NaCl over one hour, and draw arterial blood gases, complete blood count with differential, urinalysis, serum glucose, BUN, electrolytes, chemistry profile, and creatinine levels STAT. Obtain electrocardiogram, chest radiograph, and specimens for bacterial cultures, as needed.

¶ If initial serum K is < 3.3 mEq/L, hold insulin and give potassium chloride until K is >3.3 mEq/L.

Δ Serum Na⁺ should be corrected for hyperglycemia (for each 100 mg/dL glucose >100 mg/dL, add 2.0 mEq to sodium value for corrected serum sodium value).

◊ An alternative IV insulin regimen is to give a continuous intravenous infusion of regular insulin at 0.14 units/kg per hour; at this dose, an initial intravenous bolus is not necessary.