This document discusses diabetic emergencies, including hyperglycemic hyperosmolar state (HHS). It notes that HHS is characterized by severe hyperglycemia, hyperosmolarity, and dehydration without significant ketoacidosis. It most commonly occurs in older patients with type 2 diabetes due to reduced fluid intake from an illness. Signs include a plasma glucose over 600 mg/dL, effective serum osmolality over 320 mOsm/kg, and dehydration of 8-12 liters with neurologic changes like drowsiness. The pathophysiology involves reduced insulin and elevated counter-regulatory hormones leading to further hyperglycemia and a shift of fluid out of cells causing intracellular

1. 21/05/10 MOH الوكالة المساعدة للطب الوقائي الادارة العامة للأمراض غير المعدية برنامج مكافحة الداء السكري

6. unsteady walk nausea headache trembling hunger Other signs and symptoms gradual onset of unconsciousness faintness to unconsciousness developing quickly LOC like musty apple or nail polish odourless Breath odour flushed, dry and warm pale and sweating Skin deep and sighing shallow Breathing weak and rapid strong and rapid Pulse Diabetic Coma (needs insulin) Insulin Shock (needs sugar)

16. 21/05/10 Riyadh PHC / HPTD