What Is Hypertonia?

Patients with hypertonic syndrome have severe hyperglycemia, dehydration, hypernatremia, and elevated plasma osmotic pressure, but there is no obvious ketoacidosis, and patients often have conscious disturbances or coma. Blood glucose: more than 33.3mmol / L (600mg / dl), up to 111.1mmol / L (2000mg / dl). Blood sodium and potassium. Blood sodium is often increased, more than 145.0mmol / L, blood potassium is normal or decreased, and a few can be increased. Blood urea nitrogen (BUN) and creatinine (Cr): often significantly increased, reflecting severe dehydration and renal insufficiency.

Hypertonic syndrome

Chinese name: Hypertonic syndrome
nickname: Have severe hyperglycemia, dehydration, hypernatremia, and elevated plasma osmolality

Presenter: laboratory
Applied discipline: medicine

1. Stress and infections such as cerebrovascular accidents, acute myocardial infarction, acute pancreatitis, gastrointestinal bleeding, trauma, surgery, heat stroke or hypothermia. Infections, especially upper respiratory tract infections and urinary tract infections, are most often induced.

2. Insufficient water intake decreases the sensitivity of the thirst of the elderly, bedridden patients, patients with mental disorders or coma, and young children who cannot actively take water.

3. Excessive dehydration and dehydration, such as severe vomiting, diarrhea, patients with large area burns, neurological and surgical dehydration treatment, dialysis treatment, etc.

4. High-sugar intake and input, such as a large intake of sugary drinks, high-sugar foods, intravenous infusion of a large amount of glucose when the diagnosis is unknown or missed, complete intravenous hypertrophy, and the use of sugary solutions for hemodialysis or peritoneal dialysis. Happening. Especially in patients with certain endocrine diseases combined with glucose metabolism disorders, such as hyperthyroidism, acromegaly, cortisol, and pheochromocytoma are more likely to be induced.

5. Drugs Many drugs can be incentives, such as the heavy use of diuretics such as glucocorticoids, thiazines or furosemide (fast urine), propranolol, phenytoin, chlorpromazine, cimetidine, glycerol , Azathioprine and other immunosuppressants. Can cause or aggravate the body's insulin resistance and increase blood sugar

1) Blood sugar: more than 33.3mmol / L (600mg / dl), up to 111.1mmol / L (2000mg / dl). Such as less than 20mmol / L (360mg / dl) can rule out the disease.

2) Blood sodium and potassium. Blood sodium is often increased, more than 145.0mmol / L, blood potassium is normal or decreased, and a few can be increased. But regardless of plasma levels, overall sodium and potassium are lost. In addition, calcium, magnesium and phosphorus are often lost.

3) Blood urea nitrogen (BUN) and creatinine (Cr): often significantly increased, reflecting severe dehydration and renal insufficiency. BUN can reach 21-36mmol / L (60-100mg / dl), Cr can reach 123-660mmol / L (1.4-7.5mg / dl), BUN / Cr can reach 30/1, and normally it is 10-20 / 1 .

4) Plasma osmotic pressure: Plasma osmotic pressure can be measured directly or calculated based on blood glucose and plasma electrolyte levels. Calculated as follows:

Plasma osmolality (mmol / L) = 2 ([Na +] + [K +] + Glycemic / 18 + BUN / 2.8

In the formula, the unit of sodium and potassium ions is mmol / L, the unit of blood glucose and BUN is mg / dl, because the molecular weight of glucose is 180, the BUN molecule contains 2 nitrogen atoms, and the sum of the nitrogen atom weight is 28. For mmol / L, divide blood sugar and BUN by 18 and 2.8, respectively. Normal human plasma osmotic pressure is 280-300mmol / L, exceeding 350mmol / L, can be diagnosed as hypertonic, which is an important feature and diagnostic basis of diabetic non-ketotonic hypertonic syndrome. Since BUN can pass through the cell membrane freely and cannot constitute the effective osmotic pressure of extracellular fluid, some people have suggested that the BUN should be omitted in the calculation, and the formula for calculating the effective osmotic pressure of plasma is as follows

Effective plasma osmolality (mmol / L) = 2 ([Na +] + [K +] + blood glucose / 18

The effective osmotic pressure of diabetic non-ketotic hyperosmolar syndrome is higher than 320mmol / L.

5) Acid-base balance: About half of patients have mild or moderate metabolic acidosis. It shows that the anion gap is enlarged, the serum bicarbonate ion level and pH are decreased, and the pH is usually higher than 7.3.

6) Urine glucose and ketone bodies: urine sugar is more strongly positive; ketone bodies are mostly negative or weakly positive.

When encountering patients with conscious disturbance or coma, the diagnosis is not difficult as long as they think of diabetic non-ketotonic hypertonic syndrome. Generally, blood glucose is greater than or equal to 33mmol / L (600mg / dl), effective osmotic pressure of plasma is greater than or equal to 320mmol / L, serum [HCO3-] is greater than or equal to 15mmol / L, or arterial blood gas pH is greater than or equal to 7.30 to diagnose.

1. Regularly self-monitor blood glucose to maintain good blood glucose control. 2. Elderly people have an increased thirst threshold. They must ensure sufficient water intake and encourage active drinking.

3. For those who have central nervous system dysfunction and cannot actively drink water, record daily intake and output to ensure water and electrolyte balance.

4. Due to other diseases, diabetic patients should monitor blood glucose, blood sodium and osmotic pressure when using dehydration treatment.

5. In the case of vomiting, diarrhea, burns, severe infections and other diseases in diabetic patients, it is necessary to ensure that sufficient water is provided.

6. Nasal dieters often give high-energy mixed milk to ensure energy supply, and plan daily water intake and daily urine output.

(1) Take necessary measures to ensure the stability of vital signs.

(2) Keep the airway open.

(3) Inhale oxygen if necessary.

(4) Keep the venous channels open.

(5) ECG monitoring when necessary.

(6) The patient's consciousness, breathing, heart rate, blood pressure and peripheral circulation are closely monitored on the way.