Signs and symptoms common in hyperglycemic hyperosmolar nonketotic client is thirsty, warm and dry skin, nausea and vomiting, decreased appetite (weight loss), abdominal pain, dizziness, blurred vision, a lot of urine, tiredness, polydipsia, polyuria, impairment of consciousness.
The symptoms include:
1. Somewhat sleepy stupor incident, often comma.
2. Polyuria for 1 -3 days before clinical symptoms arise.
3. No hyperventilation and no bad breath.
4. Very excessive volume depletion (dehydration, hypovolemia).
5. Serum glucose reaches 600 mg / dl to 2400 mg / dl.
6. Sometimes there are gastrointestinal symptoms.
8. Failure that resulted in the thirst mechanism is inadequate digestion of water.
9. High serum osmolarity with minimal CNS symptoms (disorientation, convulsions local).
10. Impaired renal function.
11. HCO3 levels less than 10 mEq / L.
12. Normal CO2 levels.
13. Anion gap is less than 7 mEq / L.
14. Serum potassium is usually normal.
15. No ketonemia.
16. Mild acidosis.
Pathophysiology of Hyperglycemic Hyperosmolar Nonketotic
Hyperglycemic hyperosmolar nonketotic syndrome portrait of insulin deficiency, and excessive hormone glucagon. Decrease insulin resistance causes glucose movement into cells, resulting in the accumulation of glucose in plasma. Increase in the hormone glucagon which causes glycogenolisis can increase plasma glucose levels. Increased glucose levels lead to hyperosmolar. Serum hyperosmolar conditions would attract intracellular fluid into the intra vascular, which can lower the intracellular fluid volume. If the client does not feel the sensation of thirst will cause dehydration.
High levels of serum glucose are excreted in the kidneys, causing glycosuria which can lead to excessive osmotic diuresis (polyuria). The impact of polyuria would cause excessive fluid loss, and followed the loss of potassium, sodium and phosphate.
Due to lack of insulin the glucose can not be converted into glycogen to increase blood sugar levels and hyperglycemia occurs. The kidneys can not resist hyperglycemia, because the threshold for blood sugar was 180 mg% in case of hyperglycemia so that the kidneys can not filter out and absorb the amount of glucose in the blood. With respect to the nature of the sugar which absorbs all the excess water removed with the urine is called glucosuria. Simultaneously the state of glucosuria then some water is lost in the urine is called polyuria. Polyuria resulting in intra cellular dehydration, this will stimulate the thirst center so that patients will feel constantly hungry, so the patient will continue to drink the so-called polidipsi. Decreased renal perfusion resulting in increased secretion of the hormone over again and hyperglycemic hyperosmolar arise.
The lack of insulin production will cause a decrease in glucose transport into the cells so the cells are starved of food and stores carbohydrates, fats and proteins to be depleted. Because it is used to burn the body, then the client will feel hungry eat, causing many so-called poliphagia.
Failure to restore the body's homeostasis situation will lead to hyperglycemia, hyperosmolar, excessive osmotic diuresis and dehydration. Central nervous system dysfunction due to transport oxygen to the brain disorder and tends to be a comma.
Hemoconcentration increases the blood viscosity which may lead to the formation of blood clots, thromboembolism, cerebral infarction, heart.