The nurse is explaining the pathophysiology of hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Which statement will the nurse include when teaching? HHNS:
1. Is accompanied by severe metabolic acidosis
2. Results in cellular overhydration and interstitial space dehydration
3. Causes severe dehydration from very high osmolarity
4. Causes a severe decline in glucose production, resulting in increased metabolic rates to burn fat for energy
3
Rationale 1: If present at all, metabolic acidosis is minimal in HHNS because there is some insulin present to allow glucose into the cells for cellular metabolism.
Rationale 2: Cells are not over-hydrated but instead are dehydrated.
Rationale 3: HHNS is a hyperglycemic state. The body removes glucose with water through the kidneys via osmotic diuresis. This causes severe vascular, interstitial, and cellular water losses, resulting in severe dehydration.
Rationale 4: Glucose production is increased rather than decreased.
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