Arctickat Posted September 17, 2013 Author Share Posted September 17, 2013 The old term for his condition is HONK. Hyperosmolar nonketotic state. Now known as Diabetic Hyperglycemic Hyperosmolar Syndrome. http://www.nlm.nih.gov/medlineplus/ency/article/000304.htm Link to comment Share on other sites More sharing options...
triemal04 Posted September 17, 2013 Share Posted September 17, 2013 Interesting. Was that the actual diagnosis, and did they run any other labs, and hopefully an ABG? From what you gave it almost seems like it could go either way. Link to comment Share on other sites More sharing options...
Arctickat Posted September 17, 2013 Author Share Posted September 17, 2013 I am awaiting an authorisation to access the medical records from the family for the other hospital he was transferred to. However the cardio docs agreed. Link to comment Share on other sites More sharing options...
scubanurse Posted September 17, 2013 Share Posted September 17, 2013 Any idea if he was a type 1 or type 2 diabetic? Link to comment Share on other sites More sharing options...
ERDoc Posted September 17, 2013 Share Posted September 17, 2013 I don't know, I would question HONK. Usually with HONK, your glucose is much higher, think 600 (33.3) and up. There are also ketones in the urine so it's hard to say he's not ketotic. Usually with a chem profile you get a bicarb which would help differentiate this. The things that go against DKA are the age, this guy probably has type 2 DM, which is more likely to result in HONK. DKA is more likely in type 1. This guy may just be septic which can result in hyper or hypoglycemia. Link to comment Share on other sites More sharing options...
DartmouthDave Posted September 17, 2013 Share Posted September 17, 2013 Hello, I think in HONK your pH is as low because insulin resistance is as profound. But, I am not sure. The criteria where I work for DKA is a pH below 7.3, elevated BGL, and ketones. Nice case study. David Link to comment Share on other sites More sharing options...
paramedicmike Posted September 17, 2013 Share Posted September 17, 2013 My initial thought upon seeing the BGL was that he must be really septic for it to be so out of whack. Add in the description of the leg and that rather fueled my thoughts towards a sepsis cause of the hyperglycemia. Either way, it was a good case with some interesting discussion. Link to comment Share on other sites More sharing options...
Arctickat Posted September 18, 2013 Author Share Posted September 18, 2013 What really bothered me about this call is that the EMT on the call didn't even think to defib the guy or put on the AED, oh, and after we got to the hospital the Doc gave him Adenosine..twice because of the heart rate at 126 bpm. Fortunately the patient survived despite everyone's efforts to kill him. Link to comment Share on other sites More sharing options...
ERDoc Posted September 18, 2013 Share Posted September 18, 2013 If there is one thing medicine has taught me, killing people is hard. I had a woman once who got ROSC in the field after 30 minutes with an unknown downtime (don't ask). Ended up on an epi drip which we maxed out. Could only get her VS to 80/30 HR38. Talked with the family and decided to stop the epi. Two hours after stopping the epi, her vitals were still the same. This woman didn't seem to understand that she was dead. Finally she was asystolic after about 2.5 hours but her BP cuff went off and we got a pressure of 30/12. OK, turn the damn monitor off. Link to comment Share on other sites More sharing options...
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