Comparing Hypoglycemia & Hyperglycemia

Comparing Hypoglycemia & Hyperglycemia
	Hypoglycemia	Hyperglycemic Conditions
Terms	Hypoglycemia Diabetic coma, insulin shock, insulin reaction	DKA (diabetic ketoacidosis)	HHNC (hyperglycemic hyperosmolar nonketotic coma)
Onset	Rapid (minutes)	Gradual (days)	Gradual (weeks)
History	Recent insulin injection, inadequate meal, or excessive exercise	Infection, stress, trauma, insufficient insulin intake. More common in type-1 diabeti	Pneumonia, UTI, dehydration, ALOC, immobility. More common in type-2 diabetics
Neuro	Confusion, delirium, or coma. Increased risk for seizures	Irritability, HA, double or blurred vision.	Fatigue, impaired vision, HA, seizure, delirium, coma
CV	Rapid, weak pulse, BP variable	HR normal to fast, BP variable	Tachycardia (early), hypotension (late)
RESP	Normal	Deep and rapid (Kussmaul’s)	Tachypnea, may be depressed
Breath	Normal	Fruity odor	No fruity odor

Comparing Hypoglycemia & Hyperglycemia
	Hypoglycemia	DKA         Hyperglycemic Conditions         HHNC
Skin	Cool, pale, moist	Warm, dry, flushed	Itching, poor turgor
MS	Weakness, tremor, twitching	Muscle wasting	Weakness
GI/GU	Nausea and vomiting	Abdominal cramps, n/v, dehydrated, polydipsia, polyuria	Polyuria, decreased fluid intake
Weight	Normal	Weight loss	Weight loss
Labs	Blood glucose < 80 mg/dL	Blood glucose >180 mg/dL, glucose and ketones in urine, metabolic acidosis, respiratory alkalosis	Blood glucose > 800 mg/dL, ↑BUN, ↑H&H, ↑WBC, serum osmolality > 320 mOsm/L
Rx	Glucose IV or PO, glucagon	IV, insulin, K+, NaHCO3	IV, insulin, K+, NaHCO3

Increasing Intracranial Pressure (ICP)

Clinical Findings (Normal ICP is _ 15 mm Hg):

Neuro: ALOC, HA, sensitivity to light, irritability, double or

blurred vision, seizures, hemiparesis, GCS _8, unequal pupils.

Resp: Abnormal respirations, tachypnea (late).

CV: HTN, bradycardia (late), widening pulse pressure (late).

GI/GU: Nausea and vomiting.

MS:Weakness, decreased motor function.

Cushing’s Triad: HTN, bradycardia, and abnormal respirations.

Emergency Management (may need MD order)

■ Establish and manage ABCs and intubate if indicated.

■ Administer 100% oxygen via NRB mask or use BVM if indicated.

■ Hyperventilate Pt with 100% O2: This will result in decreased PaCo2, causing cerebral vasoconstriction, which decreases ICP.

■ Obtain IV access and titrate to hemodynamic status.

■ Insert urinary catheter and monitor strict intake and output.

■ Facilitate invasive ICP monitoring as ordered.

■ Administer prescribed medications, which may include sedatives, osmotic diuretics, corticosteroids, neuromuscular blocking agents, antiemetics, and anticonvulsants.

Special Considerations

■ Keep HOB Elevated 15_–30_.

■ Keep head in neutral alignment and avoid flexion/rotation of neck.

■ Restrict fluids and monitor fluid and electrolytes.

■ Closely monitor vital signs and neurological status (see GCS).

■ Reduce environmental stimuli.

■ Schedule procedures to coincide with periods of sedation.

■ Avoid activities that elicit a vasovagal response.