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Endocrine

Question
14 out of 14
 

Treatment of NKHOC? (LQ)



A 0.45% saline
B Regular insulin

C Subcutaneous heparin
D All of the above

Ans. D

All of the above

NON KETOTIC HYPEROSMOLAR COMA (NKHOC) (Ref: Hari- 18th ed., pg-2979)

Symptoms –Classically patient is

1). Elderly

2). H/O polyuria of several weeks with weight loss and decrease oral intake.

3). Mentally confused

Signs –

1). Tachycardia

2). Hypotension

3). Dehydration

4). Altered sensorium, coma

Extra Edge:

Nausea, Vomiting, Abdominal Pain, Kussmaul respiration & Ketosis are not the features of NKHOC.


Investigation –


1). Blood sugar 900 – 1100 mg/dl

2). Serum osmolality > 350mosm/kg

3). Prerenal azotemia


4). Pseud hyponatremia


5). pH normal i.e. no acidosis

6). Ketonuria is absent. i.e. no ketosis


Note: (1), (2), (3) are most important Features.

Treatment –

1). Fluid Total fluid deficit (9 – 10L) should be reversed over 1 –2 day

Initially give normal saline to stabilize the patients hemodynamically

Then Give 0.45% saline

2). Regular Insulin to be given intravenous

3). Subcutaneus heparin because these patients are prone to venous thrombosis.

(Ref: Hari, 18th ed., table 344.4, pg. 2976)

DKA

NKHOC

Glucose, mmol/L (mg/dL)

13.9–33.3 (250–600)

33.3–66.6 (600–1200)

Sodium, meq/L

125–135

120–130

Potassium

Normal

Phosphate

Normal

Creatinine

Slightly

Moderately

Osmolality (mOsm/mL)

300–320

330–380

Plasma ketones

++++

Serum bicarbonate (HCO3),meq/L

<15 meq/L

Normal

Arterial pH

6.8–7.3

>7.3

Arterial pCO2, mmHg

20–30

Normal

Anion gap [Na - (Cl + HCO3)]

Normal

Endocrine Flashcard List

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