NKHC

 

Etiology/Overview:

  1. Constellation  of ­ glucose, ­ osmolality but no ketones. Occurs in Type 2 DM. Pt classically  is elderly.
     
  2. Precipitating factor is usually infection. Other causes can be MI, CVA, GI bleed.
     
  3. Dehydration is significant - at least 5 L.

S & S :

  1. The most common feature is CNS abnormality. Osmolality plays a major  factor for mental status change.
     
  2. CNS changes can manifest with seizure, ¯ MS, confusion, and even with focal signs such as hemisensory loss or hemiparesis.

DX :

  1. ­ BUN,  ­ calculated osmolality, ­ glucose (800-1000), (-)ve ketones. Metabolic Acidosis with Gap and Kussmaul are not the features of  NKHC vs. DKA.

Treatment:

  1. IVF is the main goal. Pt commonly has at least 5L deficit. Correct with IVF first and then insulin to avoid rapid osmotic shift leading to cerebral edema.
     
  2. 10 U of RI via IV infusion (see above),  until FS is  300mg/dl.
     
  3. Correction  of electrolytes. Do not correct Na  until  its level is properly adjusted to hyperglycemia (see above).

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