When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse’s priority is to provide:
A. Oxygen
B. Carbohydrates
C. Fluid replacement
D. Dietary instruction
Correct Answer: C. Fluid replacement
As a result of osmotic pressures created by increased serum glucose, the cells become dehydrated; the client must receive fluid and then insulin. Aggressive hydration with isotonic fluid with electrolyte replacement is the standard practice in the management of HHS. An initial fluid bolus of 15 to 20 ml/kg followed by an infusion rate of 200 to 250ml/hour is the recommended rate for adults.
Option A: Appropriate resuscitation with attention to the principle of Airway, Breathing, Circulation (ABC) should be initiated. Patients with HHS can present with altered mental status as a result of significant fluid depletion and decreased cerebral perfusion. A good rule of thumb is to secure the airway if the Glasgow coma score is less than 8.
Option B: Hydration with isotonic fluid has been shown to help in reducing the amount of counterregulatory hormones produced during HHS. The use of this alone can reduce serum glucose by about 75 to 100 mg/hour.
Option D: The serum potassium in HHS is usually high, but the total body potassium is low as a result of the extracellular shift from lack of insulin. Potassium replacement should be started when the serum potassium is between 4 to 4.5 mmol/L.
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