Although she ate the same food, his wife did not become ill. People with type 2 diabetes are at risk for hyperglycemic hyperosmolar nonketotic syndrome HNKS , a life-threatening condition when illness is not treated and blood glucose is not controlled. What tools are available to PCPs to provide diabetes education for their patients? Serum osmolality in our case was maintained at a similar level for several hours and then decreased gradually Fig. To access free multiple choice questions on this topic, click here. His height was 5’10” and weight was lb.

Arterial Blood Gases The role of the blood gas is to determine the level of acidosis. Dobersen, MD, PhD Presentation This year-old Hispanic man with a year history of type 1 diabetes was found unresponsive by his wife of 18 years. The primary care physician PCP who had followed this patient for 6 years provided a history of a noncompliant patient who had chronic poor control as evidenced by a recent HbA 1c level of What is the liability of the PCP or insurance company when lack of education contributes to a death? Hyperglycemia in a patient with DKA results from increased hepatic and renal glucose production and impaired peripheral glucose utilization leading to osmotic diuresis and electrolyte imbalance.

In patients with type 2 diabetes, education about diabetes self-management around illness is also crucial. Hyperglycemic hyperosmolar syndrome in children: National Center for Biotechnology InformationU.

A case report of hyperosmolar hyperglycemic state in a 7-year-old child

In this case, the health management organization offers capitated care, which means that physicians either provide the education themselves or in their office or pay for the education to be provided elsewhere. Based on these findings, his death was attributed to diabetic ketoacidosis DKA.


case study of hhns

Chicago, American Association of Diabetes Educators,p. Individually wrapped Ketostix that do not expire are a sthdy for people with type 1 diabetes to have at home. Understanding the need for more frequent monitoring of blood glucose and ketones is crucial and must be taught in the context of the special effect of illness on diabetes control.

Although she ate the same food, his wife did not become ill. Klin Padiatr ; Special guidelines for this age-group may be helpful. Increasing incidence of type 1 diabetes among Stury children and adolescents: Discussion A rise in the incidence of T1DM has been observed globally in recent decades.

case study of hhns

Patients with HSS can present with altered mental status as a result of significant fluid depletion and decreased cerebral perfusion. Table 1 Laboratory results of the case. These hormones, especially in the setting of relative or absolute insulin deficiency, worsen the metabolic derangements characteristic of DKA by providing alternative fuel sources through lipolysis, glycogenolysis, and ketogenesis. No history or family history of endocrine disease including diabetes mellitus was reported.

He was pronounced dead by paramedics despite resuscitative efforts.

J Pediatr ; Vitreous humor is used for postmortem determinations of glucose, ketones, and other analytes, and the results correlate with premortem levels. To us, this case reflects one of the major disadvantages of the capitation system. Clinical Pearls Patients with hnhs must be educated about the importance of appropriate sick-day management as a part of their hhnx management.

The net effect of the production of these substances is to prevent fluid from moving from the intracellular space into extracellular space and maintain a balanced equilibrium [24].

Introduction Type 1 diabetes mellitus T1DM is characterized by low or no endogenously produced insulin due to autoimmune destruction of pancreatic beta-cells. The level of potassium might be high or low. Published by Wolters Kluwer Health, Inc. Sodium level was normalized after serum glucose level was lowered. The omission of the necessary education probably constitutes medical negligence, and, if proven to have been a direct cause of death, the family has a legal cause of action against the medical provider and the insurance company.


Low level of insulin can cause an extracellular shift of potassium. First, a comprehensive assessment of self-management knowledge should be performed, and areas of weakness should be identified.

A case report of hyperosmolar hyperglycemic state in a 7-year-old child

Incidence of type 1 diabetes mellitus during 26 years of observation and prevalence of diabetic ketoacidosis in the later years. A hyperosmolar hyperglycemic state HHS is a rare stkdy of a hyperglycemic crisis in children with diabetes mellitus. Including a spouse, parents, or supportive others may prove critical to preventing hospitalization and death from DKA. A Guide to Living Well.

The BUN and creatine levels are usually elevated reflecting prerenal azotemia. This leads to the release of counterregulatory hormones with the resultant effect of increased level of blood glucose causing osmotic diuresis, dehydration with the result being HHS.

Presentation This year-old Hispanic man with a year history of type 1 diabetes was found unresponsive by his wife of 18 years.