Hyperosmotic

offlabel · Mar 17, 2017

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.

russianbear · Mar 17, 2017

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?

offlabel · Mar 17, 2017

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

russianbear · Mar 17, 2017

Diabetes Spectrum

So with HHS they may or may not be acidotic?

BedsideNurse · Mar 18, 2017

That's an excellent link, but, actually, I feel dumber after reading it. lol.

Maybe I'll re read and see if it helps. :)

russianbear · Mar 18, 2017

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.

ClauICURN · Mar 19, 2017

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.

Cowboyardee · Mar 20, 2017

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.

russianbear · Mar 20, 2017

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.

Cowboyardee · Mar 20, 2017

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.