Hyperosmolar hyperglycemic state physical examination: Difference between revisions

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{{Hyperosmolar hyperglycemic state}}
{{Hyperosmolar hyperglycemic state}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{HS}}


==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Patients with the hyperosmolar hyperglycemic state may usually appear [[dehydrated]], [[lethargic]], [[disoriented]] and in [[shock]]. [[Physical examination]] of patients with the hyperosmolar hyperglycemic state is usually remarkable for [[hypothermia]], [[hypotension]], [[tachycardia]], [[tachypnea]], [[Nausea and vomiting|nausea]], [[vomiting]] and [[seizures]] or other [[Focal neurologic signs|focal neurological signs]].


OR
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
==Physical Examination==
==Physical Examination==
*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
===Appearance of the Patient===
===Appearance of the Patient===
Patient may look fatigue, ill-appearing, [[diaphoretic]], [[Disorientation|disoriented]] or [[Obtundation|obtunded]] due to severe [[hyperglycemia]] and [[hyperosmolality]].<ref name="urlHyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) - Endotext - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK279052/ |title=Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) - Endotext - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
Patient may look [[Dehydration|dehydrated]], ill-appearing, [[diaphoretic]], [[Disorientation|disoriented]] or [[Obtundation|obtunded]] due to severe [[hyperglycemia]] and [[hyperosmolality]].<ref name="urlHyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) - Endotext - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK279052/ |title=Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) - Endotext - NCBI Bookshelf |format= |work= |accessdate=}}</ref>


===Vital Signs===
===Vital Signs===
Line 32: Line 16:
* [[Tachycardia]]<ref name="pmid17308209" />
* [[Tachycardia]]<ref name="pmid17308209" />
* [[Tachypnea]]<ref name="pmid22127748">{{cite journal |vauthors=Rosenbloom AL |title=The management of diabetic ketoacidosis in children |journal=Diabetes Ther |volume=1 |issue=2 |pages=103–20 |year=2010 |pmid=22127748 |pmc=3138479 |doi=10.1007/s13300-010-0008-2 |url=}}</ref>
* [[Tachypnea]]<ref name="pmid22127748">{{cite journal |vauthors=Rosenbloom AL |title=The management of diabetic ketoacidosis in children |journal=Diabetes Ther |volume=1 |issue=2 |pages=103–20 |year=2010 |pmid=22127748 |pmc=3138479 |doi=10.1007/s13300-010-0008-2 |url=}}</ref>
* Weak [[pulse]] due to [[dehydration]]
* Weak [[pulse]]<nowiki/>s due to [[dehydration]]


===Skin===
===Skin===
* Poor skin [[turgor]] due to [[dehydration]]
* [[Cutaneous]] infection (non-healing [[ulcer]])<ref name="pmid25653473">{{cite journal |vauthors=Duff M, Demidova O, Blackburn S, Shubrook J |title=Cutaneous manifestations of diabetes mellitus |journal=Clin Diabetes |volume=33 |issue=1 |pages=40–8 |year=2015 |pmid=25653473 |pmc=4299750 |doi=10.2337/diaclin.33.1.40 |url=}}</ref>
* [[Cutaneous]] infection (non-healing [[ulcer]])<ref name="pmid25653473">{{cite journal |vauthors=Duff M, Demidova O, Blackburn S, Shubrook J |title=Cutaneous manifestations of diabetes mellitus |journal=Clin Diabetes |volume=33 |issue=1 |pages=40–8 |year=2015 |pmid=25653473 |pmc=4299750 |doi=10.2337/diaclin.33.1.40 |url=}}</ref>
* [[Xerosis]]<ref name="pmid25653473" />
* [[Xerosis]]<ref name="pmid25653473" />
* Hair loss<ref name="pmid25653473" />
* [[Hair loss]]<ref name="pmid25653473" />
* [[Acanthosis nigricans]] in [[Diabetes mellitus type 2|type 2 diabetics]]<ref name="urlChapter 151. Diabetes Mellitus and Other Endocrine Diseases | Fitzpatricks Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical">{{cite web |url=http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138874 |title=Chapter 151. Diabetes Mellitus and Other Endocrine Diseases &#124; Fitzpatrick's Dermatology in General Medicine, 8e &#124; AccessMedicine &#124; McGraw-Hill Medical |format= |work= |accessdate=}}</ref>  
* [[Acanthosis nigricans]] in [[Diabetes mellitus type 2|type 2 diabetics]]<ref name="urlChapter 151. Diabetes Mellitus and Other Endocrine Diseases | Fitzpatricks Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical">{{cite web |url=http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138874 |title=Chapter 151. Diabetes Mellitus and Other Endocrine Diseases &#124; Fitzpatrick's Dermatology in General Medicine, 8e &#124; AccessMedicine &#124; McGraw-Hill Medical |format= |work= |accessdate=}}</ref>  
* [[Diabetic dermopathy]] (small <1 cm, well-demarcated, atrophic depressions, macules, or papules on the pretibia) in type 2 diabetics<ref name="urlChapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors | Fitzpatricks Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical">{{cite web |url=http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138766 |title=Chapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors &#124; Fitzpatrick's Dermatology in General Medicine, 8e &#124; AccessMedicine &#124; McGraw-Hill Medical |format= |work= |accessdate=}}</ref>
* [[Diabetic dermopathy]] (small <1 cm, well-demarcated, atrophic depressions, [[Macule|macules]], or [[Papule|papules]] on the pretibial region) in type 2 diabetics<ref name="urlChapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors | Fitzpatricks Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical">{{cite web |url=http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138766 |title=Chapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors &#124; Fitzpatrick's Dermatology in General Medicine, 8e &#124; AccessMedicine &#124; McGraw-Hill Medical |format= |work= |accessdate=}}</ref>
* Eruptive [[xanthomas]] in [[Diabetes mellitus type 2|type 2 diabetics]]<ref name="pmid10815049">{{cite journal |vauthors=Paron NG, Lambert PW |title=Cutaneous manifestations of diabetes mellitus |journal=Prim. Care |volume=27 |issue=2 |pages=371–83 |year=2000 |pmid=10815049 |doi= |url=}}</ref><ref name="pmid25653473" />
* Eruptive [[xanthomas]] in [[Diabetes mellitus type 2|type 2 diabetics]]<ref name="pmid10815049">{{cite journal |vauthors=Paron NG, Lambert PW |title=Cutaneous manifestations of diabetes mellitus |journal=Prim. Care |volume=27 |issue=2 |pages=371–83 |year=2000 |pmid=10815049 |doi= |url=}}</ref><ref name="pmid25653473" />
* [[Necrobiosis lipoidica]] (irregular, painless ovoid plaques with a yellow atrophic center and a red to purple periphery)<ref name="pmid25653473" />
* [[Necrobiosis lipoidica]] (irregular, painless ovoid plaques with a yellow atrophic center and a red to purple periphery)<ref name="pmid25653473" />
* [[Vitiligo]]<ref name="pmid25653473" />
* [[Vitiligo]]<ref name="pmid25653473" />
* Diabetic bullae<ref name="pmid12170881">{{cite journal |vauthors=Ferringer T, Miller F |title=Cutaneous manifestations of diabetes mellitus |journal=Dermatol Clin |volume=20 |issue=3 |pages=483–92 |year=2002 |pmid=12170881 |doi= |url=}}</ref><ref name="pmid25653473" />
* [[Diabetic]] bullae<ref name="pmid12170881">{{cite journal |vauthors=Ferringer T, Miller F |title=Cutaneous manifestations of diabetes mellitus |journal=Dermatol Clin |volume=20 |issue=3 |pages=483–92 |year=2002 |pmid=12170881 |doi= |url=}}</ref><ref name="pmid25653473" />
* Poor skin turgor due to dehydration


===HEENT===
===HEENT===
* [[Extra-ocular]] movements may be abnormal due to the involvement of [[Oculomotor nerve palsy|third]], [[Fourth (trochlear) nerve palsy|fourth]], [[Sixth nerve palsy|sixth]], and [[Facial nerve palsy|seventh]] [[cranial nerves]] affecting [[ocular]] movements<ref name="pmid21760834">{{cite journal |vauthors=Skarbez K, Priestley Y, Hoepf M, Koevary SB |title=Comprehensive Review of the Effects of Diabetes on Ocular Health |journal=Expert Rev Ophthalmol |volume=5 |issue=4 |pages=557–577 |year=2010 |pmid=21760834 |pmc=3134329 |doi=10.1586/eop.10.44 |url=}}</ref>
* [[Extraocular muscle|Extra-ocular]] movements may be abnormal due to the involvement of [[Oculomotor nerve palsy|third]], [[Fourth (trochlear) nerve palsy|fourth]], [[Sixth nerve palsy|sixth]], and [[Facial nerve palsy|seventh]] [[cranial nerves]] affecting [[ocular]] movements.<ref name="pmid21760834">{{cite journal |vauthors=Skarbez K, Priestley Y, Hoepf M, Koevary SB |title=Comprehensive Review of the Effects of Diabetes on Ocular Health |journal=Expert Rev Ophthalmol |volume=5 |issue=4 |pages=557–577 |year=2010 |pmid=21760834 |pmc=3134329 |doi=10.1586/eop.10.44 |url=}}</ref>
* [[Ophthalmoscopic]] exam may be abnormal with findings of [[diabetic retinopathy]].
* [[Ophthalmology|Ophthalmoscopic]] exam may be abnormal with findings of [[diabetic retinopathy]].
* Hearing acuity may be reduced.
* Hearing acuity may be reduced.
*Sunken eyes due to dehydratiohn.
*Sunken eyes due to [[dehydration]].


===Neck===
===Neck===
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===Heart===
===Heart===
*Chest tenderness upon palpation
* [[Heart sounds|S1]] normal
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
* [[Heart sounds|S2]] normal
*[[Heave]] / [[thrill]]
* [[The U Wave|U wave]] ([[hypokalemia]])<ref name="pmid25430801">{{cite journal |vauthors=Davis SM, Maddux AB, Alonso GT, Okada CR, Mourani PM, Maahs DM |title=Profound hypokalemia associated with severe diabetic ketoacidosis |journal=Pediatr Diabetes |volume=17 |issue=1 |pages=61–5 |year=2016 |pmid=25430801 |pmc=4896141 |doi=10.1111/pedi.12246 |url=}}</ref>
*[[Friction rub]]
* [[Cardiac arrhythmia]] ([[Atrial fibrillation]] and [[Ventricular arrhythmias|ventricular arrhythmia]])<ref name="pmid26862372">{{cite journal |vauthors=Koektuerk B, Aksoy M, Horlitz M, Bozdag-Turan I, Turan RG |title=Role of diabetes in heart rhythm disorders |journal=World J Diabetes |volume=7 |issue=3 |pages=45–9 |year=2016 |pmid=26862372 |pmc=4733448 |doi=10.4239/wjd.v7.i3.45 |url=}}</ref>
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope


===Abdomen===
===Abdomen===
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* [[Restlessness]]
* [[Restlessness]]
* [[Stupor]]
* [[Stupor]]
* [[Muscular twitching]]
* [[Muscle twitching|Muscular twitching]]
* [[Hyperreflexia]]
* [[Hyperreflexia]]
* [[Lethargy]]
* [[Lethargy]]
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{{WH}}
{{WH}}
{{WS}}
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[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Up-To-Date]]
​
[[Category:Emergency medicine]]

Latest revision as of 18:09, 23 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

Overview

Patients with the hyperosmolar hyperglycemic state may usually appear dehydrated, lethargic, disoriented and in shock. Physical examination of patients with the hyperosmolar hyperglycemic state is usually remarkable for hypothermia, hypotension, tachycardia, tachypnea, nausea, vomiting and seizures or other focal neurological signs.

Physical Examination

Appearance of the Patient

Patient may look dehydrated, ill-appearing, diaphoretic, disoriented or obtunded due to severe hyperglycemia and hyperosmolality.[1]

Vital Signs

Skin

HEENT

Neck

  • Not significant

Lungs

Heart

Abdomen

Back

  • Not significant

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ "Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) - Endotext - NCBI Bookshelf".
  2. ↑ Gale EA, Tattersall RB (1978). "Hypothermia: a complication of diabetic ketoacidosis". Br Med J. 2 (6149): 1387–9. PMC 1608617. PMID 102402.
  3. ↑ 3.0 3.1 3.2 3.3 Kearney T, Dang C (2007). "Diabetic and endocrine emergencies". Postgrad Med J. 83 (976): 79–86. doi:10.1136/pgmj.2006.049445. PMC 2805944. PMID 17308209.
  4. ↑ Rosenbloom AL (2010). "The management of diabetic ketoacidosis in children". Diabetes Ther. 1 (2): 103–20. doi:10.1007/s13300-010-0008-2. PMC 3138479. PMID 22127748.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 Duff M, Demidova O, Blackburn S, Shubrook J (2015). "Cutaneous manifestations of diabetes mellitus". Clin Diabetes. 33 (1): 40–8. doi:10.2337/diaclin.33.1.40. PMC 4299750. PMID 25653473.
  6. ↑ "Chapter 151. Diabetes Mellitus and Other Endocrine Diseases | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical".
  7. ↑ "Chapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical".
  8. ↑ Paron NG, Lambert PW (2000). "Cutaneous manifestations of diabetes mellitus". Prim. Care. 27 (2): 371–83. PMID 10815049.
  9. ↑ Ferringer T, Miller F (2002). "Cutaneous manifestations of diabetes mellitus". Dermatol Clin. 20 (3): 483–92. PMID 12170881.
  10. ↑ Skarbez K, Priestley Y, Hoepf M, Koevary SB (2010). "Comprehensive Review of the Effects of Diabetes on Ocular Health". Expert Rev Ophthalmol. 5 (4): 557–577. doi:10.1586/eop.10.44. PMC 3134329. PMID 21760834.
  11. ↑ Konstantinov NK, Rohrscheib M, Agaba EI, Dorin RI, Murata GH, Tzamaloukas AH (2015). "Respiratory failure in diabetic ketoacidosis". World J Diabetes. 6 (8): 1009–23. doi:10.4239/wjd.v6.i8.1009. PMC 4515441. PMID 26240698.
  12. ↑ Davis SM, Maddux AB, Alonso GT, Okada CR, Mourani PM, Maahs DM (2016). "Profound hypokalemia associated with severe diabetic ketoacidosis". Pediatr Diabetes. 17 (1): 61–5. doi:10.1111/pedi.12246. PMC 4896141. PMID 25430801.
  13. ↑ Koektuerk B, Aksoy M, Horlitz M, Bozdag-Turan I, Turan RG (2016). "Role of diabetes in heart rhythm disorders". World J Diabetes. 7 (3): 45–9. doi:10.4239/wjd.v7.i3.45. PMC 4733448. PMID 26862372.
  14. ↑ Yun C, Xuefeng W (2013). "Association between seizures and diabetes mellitus: a comprehensive review of literature". Curr Diabetes Rev. 9 (4): 350–4. PMID 23590576.
  15. ↑ Wyatt LH, Ferrance RJ (2006). "The musculoskeletal effects of diabetes mellitus". J Can Chiropr Assoc. 50 (1): 43–50. PMC 1839979. PMID 17549168.

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