Hyperosmotic

  1. So, the other day I was giving report from the ED to ICU. Lady was elderly. Blood glucose over 700, etc. I told the arrogant nurse she was in compensated metabolic acidosis. He said, "She's hyperosmotic. She can't be in metabolic acidosis." True?
    •  
  2. 10 Comments

  3. by   offlabel
    Not nearly enough information here. Was it DKA or non-ketotic hyperosmolar hyperglycemia? Acidemia with the former, not necessarily with the latter. You can have a hyperosmolar patient in DKA.
  4. by   russianbear
    Quote from offlabel
    Not nearly enough information here. Was it DKA or non-ketotic hyperosmolar hyperglycemia? Acidemia with the former, not necessarily with the latter. You can have a hyperosmolar patient in DKA.
    I don't recall the numbers exactly, but she had no history of diabetes. Blood sugar was over 700. Although there, I do believe the attending's diagnosis was hyperglycemia.
    could you explain that please? Like, how you're not considered a idiotic liar f your pH shows you are, or at the very least you're showing compensated acidosis if you're hyperosmotic?
  5. by   offlabel
    Quote from russianbear
    I don't recall the numbers exactly, but she had no history of diabetes. Blood sugar was over 700. Although there, I do believe the attending's diagnosis was hyperglycemia.
    could you explain that please? Like, how you're not considered a idiotic liar f your pH shows you are, or at the very least you're showing compensated acidosis if you're hyperosmotic?

    Diabetes Spectrum
  6. by   russianbear
    Quote from offlabel
    So with HHS they may or may not be acidotic?
  7. by   BedsideNurse
    That's an excellent link, but, actually, I feel dumber after reading it. lol.
    Maybe I'll re read and see if it helps.
  8. by   russianbear
    Quote from BedsideNurse
    That's an excellent link, but, actually, I feel dumber after reading it. lol.
    Maybe I'll re read and see if it helps.
    I know those feels.
  9. by   ClauICURN
    If the ABG results show the patient was in compensated metabolic acidosis... then the patient was in compensated metabolic acidosis. I'm a bit confused.
  10. by   Cowboyardee
    Quote from russianbear
    So with HHS they may or may not be acidotic?
    HHS typically presents with either no acidosis or very mild acidosis. Also with no real elevation of serum ketones and a normal or low anion gap (assuming no concurrent illness that might affect these values).

    It's not clear from your description exactly what happened in the exchange in your OP, or exactly what was going on with the patient. It's common for people to mix up DKA (an acidotic state marked by hyperglycemia among other things) and HHS (a mostly non-acidotic state also marked by hyperglycemia), so it seems possible that this issue tripped you up. On the other hand, if your ABG showed a compensated metabolic acidosis and you read it correctly, then the patient had a compensated metabolic acidosis regardless of the diagnosis or what the ICU nurse said.
  11. by   russianbear
    Quote from Cowboyardee
    HHS typically presents with either no acidosis or very mild acidosis. Also with no real elevation of serum ketones and a normal or low anion gap (assuming no concurrent illness that might affect these values).

    It's not clear from your description exactly what happened in the exchange in your OP, or exactly what was going on with the patient. It's common for people to mix up DKA (an acidotic state marked by hyperglycemia among other things) and HHS (a mostly non-acidotic state also marked by hyperglycemia), so it seems possible that this issue tripped you up. On the other hand, if your ABG showed a compensated metabolic acidosis and you read it correctly, then the patient had a compensated metabolic acidosis regardless of the diagnosis or what the ICU nurse said.
    I found my notes with lab values. Anion gap was slightly elevated. 2+ protein in urine. PH 7.40, CO2 28, bicarbonate 17.3. Physicians diagnosis was DKA. I think the ICU nurse was trying to show off, but was wrong.
  12. by   Cowboyardee
    Quote from russianbear
    I found my notes with lab values. Anion gap was slightly elevated. 2+ protein in urine. PH 7.40, CO2 28, bicarbonate 17.3. Physicians diagnosis was DKA. I think the ICU nurse was trying to show off, but was wrong.
    Sounds like it.

close