In many hospitals these patients are managed by non-specialist teams, and it is not uncommon for the most junior member, who is least likely to be aware of the. Asuhan Keperawatan Pada An. R Dengan Gangguan Sistem Pernafasan Asma Di Ruang Melati II Rumah Sakit Dr. Moewardi\ud. Provided by: UMS Digital. Course and prognosis of patients with diabetic non ketotic hyperosmolar state. Diabete Metab. ;– [PubMed]. Wachtel TJ.

Author: Arashilkree Tuktilar
Country: Cape Verde
Language: English (Spanish)
Genre: History
Published (Last): 4 October 2007
Pages: 393
PDF File Size: 17.38 Mb
ePub File Size: 13.70 Mb
ISBN: 205-6-72300-893-1
Downloads: 49714
Price: Free* [*Free Regsitration Required]
Uploader: Datilar

Detailed case reports of diabetic coma without ketones and hyperosmolality.

Hyperglycaemic Hyperosmolar Nonketotic Coma (HONK)

For example, there remain questions on which fluid should be used [ 49 ] and whether the use of bicarbonate alters the outcomes in those with low pH. Prediabetes Gestational Type 1. Hyperosmolarity and acidosis in diabetes mellitus: Studies on mechanisms of cerebral edema in diabetic comas. One of the reasons is due to availability of resources.

Author information Article notes Copyright and License information Disclaimer. However, with continued osmotic diuresis, hypovolemia eventually occurs, which leads to a progressive decline in glomerular filtration rate and worsening hyperglycemia.

Plasma acid-base patterns in diabetic ketoacidosis. Clin Geriatr Med ; 6: They also observed that rapid normalization of plasma glucose due to insulin and hypotonic fluid administration resulted in gross brain edema as a result of an osmotic gradient between brain and plasma S94—S [ PubMed ]. Agreement between arterial and central venous values for pH, bicarbonate, base excess, and lactate.


Most cases of HHS are hiperosmolsr in elderly patients with type 2 diabetes; however, it has also been reported in children and young adults 2. Population rates for HHS hospitalizations in children between and increased by In noj who have no or minimal health hiperosmolr coverage, it would be important to consider ways or providing safe and appropriate treatment that is affordable for the patient and the caregivers.

The initial glucosuria prevents the development of severe hyperglycemia as long as the glomerular filtration rate is normal. Any estimation of urine ketones collected in this way will be an average of the concentration within the urine held in the bladder since the last void. NS, normal saline 0. Intravenous insulin should be started at weight-based, fixed-rate intravenous insulin at 0. Med Clin North Am ; The ADA guidelines recommend initial treatment with 1—1. J Thromb Haemost ; 5: Bull Mem Soc Med Paris ; Curr Pharm Des ; New-onset diabetes and ketoacidosis with atypical antipsychotics.

Treatment of diabetic coma with continuous low-dose infusion of insulin.

Research Artificial pancreas Encapsulation. Unlike the UK, they recommend that 0. Diabetic ketoacidosis, Management, Survey, Hyperglycemic hyperosmolar state.


Diabetic ketoacidosis and the hyperglycemic hyperosmolar nonketotic state. Roefaro J, Mukherjee SM. Evolution of Ketogik treatment In the 19th century and preinsulin era, a large number of treatment modalities were recommended to treat diabetic coma.

Report of neurosurgical cases with a review of mechanisms and treatment. Severe diabetic stupor without ketosis.

Hyperglycaemic Hyperosmolar Nonketotic Coma (HONK)

Role of sodium in the pathogenesis of the neurologic manifestations. Similarly, prospective studies are needed to settle the long-term controversy regarding the use of anticoagulant therapy in patients with hyperglycemic crises.

Diabetic ketosis; a comparison of results of orthodox and intensive methods of treatment based on consecutive cases. These metabolic derangements result from synergistic factors including insulin deficiency and increased levels of counterregulatory hormones glucagon, catecholamines, cortisol, and growth hormone 31 — US Perspective Because of its ability to pass freely across plasma membranes, the ADA guidelines recommend calculation of serum osmolality without the inclusion of blood urea nitrogen.

J Am Med Assoc ; There are several potential implications of these differences. Minerva Endocrinol ;