hello and welcome to our lecture on hyperosmolar hyperglycemic state we'll start off by talking about the pathophysiology of hyperosmolar hyperglycemic state then we'll move on and cover the symptoms seen in this disease and finally we'll finish off by discussing the lab values and treatment these type of patients so let's get started [Music] hyperosmolar hyperglycemic state is a life-threatening medical emergency that is commonly seen in patients with type 2 diabetes medicines that have restricted fluid intake severe dehydration and hyperosmolarity are the key defining features of this disease in contrast to diabetic ketoacidosis which we discussed in our previous video in hyperosmo hyperglycemic state none or minimal ketone bodies are formed so ketoacidosis does not normally occur we'll expand more on this in the following slides let's go through a flow chart to see the series of events that take place prior to hypro's motor hyperglycemic state so we start off with a relatively low insulin levels that favors glucose function stress can induce production of catecholamines that can also upregulate glucagon production that favors this pathway as well glucagon then functions in the liver to increase glucose production increase glycogenolysis and decrease utilization of glucose all of this then raises the total blood glucose levels now this problem worsens when the patient is not consuming enough fluids throughout his or her day because restricting fluid intake in addition to hyperglycemia increases the osmolarity of the blood hence the name of the disease hyperosmolar hyperglycemic state an important point to mention is that no ketone bodies are formed as some amount of insulin is still present preventing ketoacidosis hence differentiating the disease from diabetic ketoacidosis let's look at the symptoms seen in hyperosmolar hyperglycemic state glucose gets filtered out by the kidneys into the urine causing glycorea on its way out glucose pulls water with it this again reduces the total bodily fluids and causes dehydration that further worsens the hypero's motor hyperglycemic state in the central nervous system hyper-is molarity in the bloodstream pulls water out of cns causing altered mental status which can progress to coma and severe cases laboratory findings in this type of patient will give you very high blood glucose levels usually more than 600 milligram per deciliter since no acidosis occur ph will be more than 7.3 urine and blood ketones will be absent again ketone bodies are not formed due to minimal amount of ketone being present anion gap will be less than 12 and finally serum molarity will be greater than 320 milliwatt molar per kilogram so the key findings you should focus on in hyperosmolar hyperglycemic state are the glucose levels which usually will be higher than 600 milligram per deciliter and serum osmolarity will be more than 320 milli molar per kilogram when treating a patient with hyperosmolar hyperglycemic state our goal is to reduce the high glucose levels by administering insulin and manage the hyperosmolarity by giving iv fluids however there is one thing to be careful of when giving insulin to these type of patients potassium levels which are although within their normal range in these patients will shift intracellularly when insulin is given how does this happen the sodium potassium pump here which is present in many cells of the body is stimulated by insulin the pump then goes on to exchange potassium outside the cell with the sodium inside the cell so after administering insulin it is possible to develop hypokalemia to prevent this we also need to add potassium to iv fluids a few hours after we have started the therapy so that's all for hyperosmolar hyperglycemic state i really hope everything made sense if you found this video helpful please give it a like and comment down in the comment section below and please make sure to subscribe to our channel until next time