DKA vs.

HHNS
Pathophysiology Course

DKA HHNS
Pathophysiology Pathophysiology
HEADACHE &
CONFUSION

FRUITY BREATH TYPE 1–FASTER & YOUNGER TYPE 2–SLOWER & OLDER “H COMES
“D COMES 1ST IN ALPHABET” 2ND IN ALPHABET”
S–SEPSIS (INFECTION) NCLEX TIP ILLNESS
S–SICKNESS "STOMACH VIRUS & FLU" INFECTIONS
(MOST COMMOM) OLDER AGE HARDER TO FIX
NO FRUITY BREATH

S–STRESS (SURGERY)
S–SKIP INSULIN EASIER FIX
ABDOMINAL PAIN
Signs & Symptoms
Signs & Symptoms
H–HIGHEST SUGAR OVER-600+ NO ABDOMINAL PAIN

D–DRY & HIGH SUGAR 250-500+ NCLEX TIP
K–KETONES & KUSSMAUL RESP.
(DEEP/RAPID/REGULAR RESPIRATIONS
AND FRUITY BREATH) NCLEX TIP
A–ABDOMINAL PAIN
A–ACIDOSIS METABOLIC LESS THAN 7.35
(NORMAL 7.35—7.45)
HYPERKALEMIA (ABNORMALLY HIGH K+)
H–HIGHER fluid loss & Extreme
dehydration NCLEX TIP
H–Head change–LOC, Confusion, Neurological
Manifestations
N–No ketones No Acid, (NO fruity breath/
ketones)
S–Slower Onset & Stable Potassium (3.5-5.0)

Treatment Treatment

D–Dehydration FIRST! (0.9% normal saline) NCLEX TIP

K–Kill the sugar (SLOWLY) prevent low sugar H–Hydration–0.9% NS 1st, then HYPOtonic NCLEX TIP
*Hourly BS checks* “land the plane slow & smooth” S–Stabilize Sugars (Insulin)
Over 250: IV Regular insulin ONLY (bolus 1st) CAUTION: Insulin IV = ONLY Regular Insulin NCLEX TIP
Below 200 (or ketones resolve): SQ insulin + 1/2 NS • IV bolus
with D5W IV • IV titration
A–Add Potassium K+ (Yes even if norm: 3.5 - 5.0) • SQ injection & IV
During IV Insulin NCLEX TIP • SQ only
IN-sulin = sugar & K+ IN the cell

Common NCLEX Question

Q:Child is nauseous NOT eating—maybe vomiting—do you
still give INSULIN?
DKA patients DIE from hypokalemia where
HHNS patients die from hypovolemia
A: Yes, we give sick day insulin to prevent DKA...
because glucose is HIGH during times of illness.

Re-Assessment Potassium Pumps Muscles

Blood Glucose Hourly
Re-Hydration Signs: High Potassium (5.0+) Low Potassium (Below 3.5)
• BP stable & Cap Refill (3 sec or less) High Pump Low Pump
• Skin color & warm temp (NOT cool/pale) Peaked T waves, ST elevation Flat T wave, ST depression, U wave
• 30ml/hr + Urine Output
• Low spec gravity (1.005–1.030)
NOT Apical pulse NOT Lung sounds NOT Pupils

Potassium IV (Normal 3.5 - 5.0)

O2
• First Action = Heart monitor
Never push = DEATH
• 10–20 mg MAX per hour IV!! (IV Pump)
• Site (central) and Slow infusion Normal ST elevation ST Depression