علاج حالة فرط سكر الدم مع فرط الأسمولية

References

• Commence IV 0.9% sodium chloride – 1 litre to run over 1 hour
• Using 0.9% sodium chloride solution aim to give a further 0.5–1 litre/hr depending on clinical assessment of dehydration vs. risk of precipitating heart failure.
• The target is to achieve positive fluid balance of 2–3 litres by 6 hours
• Continue IV fluid replacement to achieve positive balance of 3–6 litres by 12 hours
• Potassium should be replaced or omitted as required (see Table 2).
• Everyone with HHS should receive prophylactic low molecular weight heparin (LMWH) for the full duration of admission unless contraindicated.
• Heel protectors and an appropriate mattress should be provided for those with immobility, neuropathy, peripheral vascular disease or lower limb deformity.
• The fall in osmolality should not be more than 3.0–8.0 mOsm/kg/hr to minimise the risk of neurological complications
• The fall in glucose should not be more than 5.0 mmol/L/hr
• The rate of fall of serum sodium should not exceed 10 mmol/L in 24 hours
• Maintain accurate fluid balance chart (minimum urine output 0.5 ml/kg/hr)

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