Identify and discuss any abnormal laboratory values measured upon his admission. How did they change after hydration and initial treatment of his HHS?
What will be an ideal response?
Initial lab values:
• Glucose: 1524 mg/dL (high) – due to HHS with dehydration.
• Creatinine: 1.9 mg/dL (high) – elevated due to admitting dehydration.
• Sodium: 132 meq/L (low) – osmotic diuresis. Loss of sodium in urine.
• Phosphate: 1.8 (low) – osmotic diuresis; loss of phosphate in urine; kidney function may be impaired due to very high level of hyperglycemia.
• Cholesterol: 205 mg/dL (high) – related to cardiovascular risk factors and diagnosis of hyperlipidemia
• HbA1c: 11.5% (high) – average blood glucose levels are very high as patient has uncontrolled type 2 diabetes and is not taking his medications as prescribed.
• C-peptide: 1.10 – means that patient is producing insulin, but insulin resistance is a problem.
• Osmolality: 322.6 mmol/kg (high) – because HHS is a hyperosmolar condition triggered by an illness and severe dehydration.
• Specific gravity (1.045) high – due to dehydration.
• BUN: 31 (high) – due to dehydration and HHS, which is a hyperosmolar condition.
• Glucose in urine: present due to diabetes. High blood glucose levels >180 mg/dL allow glucose to spill over into the urine due to impaired kidney filtration.
• Protein in urine: presence of protein in urine is indicative of impaired kidney function secondary to his diabetes.
• Triglycerides: 185 mg/dL (high) - due to diagnosis of hyperlipidemia
Changed values:
• Glucose: 475 mg/dL, lowered with insulin therapy but still high as glucose is above 200 mg/dL and patient has been NPO.
• Osmolality decreased to 303.5 mmol/kg but is still considered high.
• Sodium is still low, but is improving as pt. is receiving hydration via saline solution.
• Phosphate: still low but levels are improving as pt. is receiving electrolytes and is rehydrated.
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