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1/10/14

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.

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