17. Plan of Care
• IV access - 18G & 20G
• IVF NS 500mL Bolus
• Inj FOSOLIN 1350mg in 100mL NS over 1/2 hr
• Inj EMESET 8mg IV stat
• Inj LORAZEPAM
18. • ET intubation
• Indication : Status epileptics, vomiting and impending aspiration
• Inj MIDAZ 2mg + Inj FENTANYL 100mg +Inj SCOLINE 100mg IV stat
• Ryles tube with continuous aspiration
• Bladder catheterisation
• IVF NS 500mL Bolus 100mL per hr
• Inj PAN 40 mg IV OD
19. • Inj FENTANYL 300mcg +Inj MIDAZ 10mg in 50ml dilution @ 5ml/hr
• Inj VECURONIUM 4mg IV stat
• Head end elevated 30o
• Repeat CBG : 564mg/dl
• CBG hourly
• Inj H Actrapid @ 8U/hr infusion (if K+ >3.5)
• Admission in MICU
20. Consultant Notes
• Inj CEFTRIAXONE 1.5g IV BD
• Inj EPTOIN 100mg IV TID
• Inj H. Actrapid (SOS) sliding scale
• GRBS Q4h monitoring
• Inj PAN 40 mg IV OD
• Inj EMESET 4mg IV TID
• T. CARDIVAS 6.25mg 1-0-0
• T. ECOSPIRIN 150mg 0-1-0
21. • T. CLOPIDOGREL 150mg 0-1-0
• T. ATORVASTATIN 40mg 0-0-1
• C. PANGRAF 1.25mg (morning) 1mg (evening)
• T. CLINIDIPINE 10mg BD
22. Hyperglycaemic Hyperosmolar State
• HHS is characterised by progressives hyperglycaemia and
hyperosmolarity typically found in a debilitated patient with poorly
controlled or undiagnosed type 2 DM, limited access to water and
commonly a precipitating illness.
• Factors for development of HHS
• Insulin resistance/ deficiency
• Inflammatory state with markedly raised cytokines
• Osmotic diuresis followed by impaired renal excretion of glucose
23. • Lack of severe ketoacidosis in HHS
• Higher level of endogenous insulin inhibits lipolysis
• Lower levels of counterregulatory stress hormones
• Inhibition of lipolysis by hyperosmolar state
24. • Clinical features
• Usually elderly with comorbidities
• Nonspecific complaints
• Weakness, anorexia, fatigue, dyspnea, chest or abdominal pain
• Underlying systemic illness
• Antipsychotics or lithium are risk factors