Nonketotic Hyperosmolar Syndrome

2. Diagnosis: Nonketotic hyperosmolar syndrome

3. Condition:

4. Vital signs: q1h. Call physician if BP >160/90, <90/60; P >140, <50; R>25, <10; T >38.5° C; or urine output <20 cc/hr for more than 4 hours.

5. Activity: Bed rest with bedside commode.

6. Nursing: Input and output measurement. Foley to closed drainage. Record labs on flow sheet.

-1-2 L NS over 1h (>16 gauge IV catheter), then give 0.45% saline at 125

cc/hr. Maintain urine output >50 mL/h. -Add 20-40 mEq/L KCL when urine output adequate.

9. Special Medications:

-Insulin regular 2-3 U/h IV infusion (50 U in 250 mL of 0.9% saline). -Ranitidine (Zantac) 50 mg IV q8h or 150 mg PO bid. -Heparin 5000 U SQ q12h.

10. Extras: Portable CXR, ECG.

11. Labs: Fingerstick glucose q1-2h x 6h, then q6h. SMA 7, osmolality. SMA 12, phosphate, ketones, hemoglobin A1C, CBC. UA.

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