A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and is in HHNS. What are the components of HHNS? (Mark all that apply.)
A) Too much insulin
B) Glycosuria
C) Dehydration
D) Hyponatremia
E) Hyperglycemia
Ans: B, C, E
Feedback: HHNS is a serious condition in which hyperosmolarity and hyperglycemia predominate, with alterations of the sensorium (sense of awareness). At the same time, ketosis is usually minimal or absent. The basic biochemical defect is lack of effective insulin (ie, insulin resistance). Persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity occur.
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