The emergency department nurse cares for a client admitted with a diagnosis of hyperosmolar hyperglycemic state. The nurse understands which characteristics are commonly associated with this complication? Select all that apply.

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11ecbb05_c96f_f209_b433_c7e8ffc1f6ea_MD0009_00 Hyperosmolar hyperglycemic state is a serious complication usually associated with type 2 diabetes. With this condition, clients are able to produce enough insulin to prevent diabetic ketoacidosis but not enough to prevent extreme hyperglycemia, osmotic diuresis, and extracellular fluid deficit. Because some insulin is produced, blood glucose rises slowly and symptoms may not be recognized until hyperglycemia is extreme, often >600 mg/dL (33.3 mmol/L). This eventually causes neurological manifestations such as blurry vision, lethargy, obtundation, and progression to coma. Because some insulin is present, symptoms associated with ketones and acidosis, such as Kussmaul respirations (hyperventilation) and abdominal pain, are typically absent (Options A and D). Educational objective: Hyperosmolar hyperglycemic state differs from diabetic ketoacidosis in that it is typically associated with type 2 diabetes mellitus. Because these clients produce some insulin, severe hyperglycemia happens more slowly and is often not noted until neurological manifestations occur.

The Emergency Department Nurse Cares for a Client Admitted with a Diagnosis