HHNK or HHNS

[transducen, BSN, RN]

In these disorders with the blood sugar, is it possible to bring the BG down too fast? I had a patient come in at 0800 with a BG of 825. By 17:30 he was down to 186. Is this okay? His drip was titrated anywhere from 10-20 units/per hour.

[turnforthenurse, MSN, NP]

It is possible to bring it down too fast...blood sugar should be decreased by ~75-100mg/dL/hr because any faster and you risk cerebral edema. It took 9.5 hours for this patient to go from a BS of 825 to 186, which is a reduction in the blood sugar of about 87mg/dL each hour.

[transducen, BSN, RN]

Could you post that formula?

[transducen, BSN, RN]

Anyone?

[turnforthenurse, MSN, NP]

There is no specific "formula," just simple math. Let's say you want to bring the blood sugar down by 75mg/dL each hour. Patient's blood sugar is 825, so after the first hour it would be 750mg/dL (825-75 = 750). There should be a protocol in place that is used to determine how to titrate the insulin gtt based on the patient's blood sugar. If you notice too rapid of a drop in blood sugar, then you need to speak with the physician.

[transducen, BSN, RN]

Thx! Unfortunately our facility is lacking in protocols.

[turnforthenurse, MSN, NP]

Thx! Unfortunately our facility is lacking in protocols.

Then perhaps you should bring it up to management so that you can implement a protocol

One other thing I forgot to mention about too rapid of a drop in blood sugar...remember that insulin drives potassium into the cell, leading to hypokalemia. In HHNKS, the patient already has a low potassium from the osmotic diuresis (and there is also no acidosis associated with HHNKS, unlike in DKA...remember acidosis causes hyperkalemia). If you drop the sugar too rapidly, you'll cause hypokalemia rapidly and the patient can develop some dangerous arrhythmias as a result.