Hyperosmolar hyperglycemic state physical examination

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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

Poor skin turgor due to dehydration
Cutaneous infection (non-healing ulcer)^[5]
Xerosis^[5]
Hair loss^[5]
Acanthosis nigricans in type 2 diabetics^[6]
Diabetic dermopathy (small <1 cm, well-demarcated, atrophic depressions, macules, or papules on the pretibial region) in type 2 diabetics^[7]
Eruptive xanthomas in type 2 diabetics^[8]^[5]
Necrobiosis lipoidica (irregular, painless ovoid plaques with a yellow atrophic center and a red to purple periphery)^[5]
Vitiligo^[5]
Diabetic bullae^[9]^[5]

HEENT

Extra-ocular movements may be abnormal due to the involvement of third, fourth, sixth, and seventh cranial nerves affecting ocular movements.^[10]
Ophthalmoscopic exam may be abnormal with findings of diabetic retinopathy.
Hearing acuity may be reduced.
Sunken eyes due to dehydration.

Neck

Not significant

Lungs

Rales/crackles due to pulmonary edema (in case of treatmnet complication) or pneumonia (in cases where infection is a precipitating cause)^[11]

Heart

S1 normal
S2 normal
U wave (hypokalemia)^[12]
Cardiac arrhythmia (Atrial fibrillation and ventricular arrhythmia)^[13]

Abdomen

Back

Not significant

Genitourinary

Polyuria^[3]

Neuromuscular

Extremities

Muscle cramping^[15]
Cold extremities^[3]

References

↑ "Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) - Endotext - NCBI Bookshelf".
↑ Gale EA, Tattersall RB (1978). "Hypothermia: a complication of diabetic ketoacidosis". Br Med J. 2 (6149): 1387–9. PMC 1608617. PMID 102402.
↑ ^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.
↑ 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.
↑ ^5.0 ^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.
↑ "Chapter 151. Diabetes Mellitus and Other Endocrine Diseases | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical".
↑ "Chapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical".
↑ Paron NG, Lambert PW (2000). "Cutaneous manifestations of diabetes mellitus". Prim. Care. 27 (2): 371–83. PMID 10815049.
↑ Ferringer T, Miller F (2002). "Cutaneous manifestations of diabetes mellitus". Dermatol Clin. 20 (3): 483–92. PMID 12170881.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ Wyatt LH, Ferrance RJ (2006). "The musculoskeletal effects of diabetes mellitus". J Can Chiropr Assoc. 50 (1): 43–50. PMC 1839979. PMID 17549168.

Template:WH Template:WS

[urlHyperglycemic_Crises:_Diabetic_Ketoacidosis_(DKA),_And_Hyperglycemic_Hyperosmolar_State_(HHS)_-_Endotext_-_NCBI_Bookshelf-1] "Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) - Endotext - NCBI Bookshelf".

[pmid102402-2] Gale EA, Tattersall RB (1978). "Hypothermia: a complication of diabetic ketoacidosis". Br Med J. 2 (6149): 1387–9. PMC 1608617. PMID 102402.

[pmid17308209-3] 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.

[pmid22127748-4] 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.

[pmid25653473-5] 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.

[urlChapter_151._Diabetes_Mellitus_and_Other_Endocrine_Diseases_|_Fitzpatricks_Dermatology_in_General_Medicine,_8e_|_AccessMedicine_|_McGraw-Hill_Medical-6] "Chapter 151. Diabetes Mellitus and Other Endocrine Diseases | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical".

[urlChapter_66._Dermal_Hypertrophies_and_Benign_Fibroblastic/Myofibroblastic_Tumors_|_Fitzpatricks_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".

[pmid10815049-8] Paron NG, Lambert PW (2000). "Cutaneous manifestations of diabetes mellitus". Prim. Care. 27 (2): 371–83. PMID 10815049.

[pmid12170881-9] Ferringer T, Miller F (2002). "Cutaneous manifestations of diabetes mellitus". Dermatol Clin. 20 (3): 483–92. PMID 12170881.

[pmid21760834-10] 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.

[pmid26240698-11] 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.

[pmid25430801-12] 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.

[pmid26862372-13] 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.

[pmid23590576-14] 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.

[pmid17549168-15] 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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