Hyperosmolar Hank — Hyperosmolar Hyperglycemic State
Type 2, glucose > 600, no ketones, profound dehydration
Hank's blood turns to syrup over ten days. There is no dramatic acid, no fruity breath — just a slow, silent drying out until his family cannot wake him.
Hank has type 2 diabetes and just enough insulin to prevent ketosis — but not enough to control glucose. Sugar climbs above 600, osmolality soars, and he becomes profoundly dehydrated and obtunded. Fluids are the mainstay; insulin comes second.
Read Hyperosmolar Hank's full story →The story arc
The setup
A urinary tract infection goes unnoticed in a 72-year-old with type 2 diabetes who lives alone.
The turn
Over a week he urinates constantly and drinks less and less because thirst perception fades with age.
The crisis
Glucose 780, osmolality 330, no ketones, pH normal — and he is unresponsive with a seizure on arrival.
The save
Aggressive isotonic fluid resuscitation first, then a low-dose insulin infusion with potassium replacement and treatment of the infection.
NCLEX study section — Hyperosmolar Hyperglycemic State
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Endocrine & Metabolic
Take this chapter into practice questions on the same topic.