DKA
A patient in DKA may display this breathing pattern.
Kussmaul respirations
This neurotransmitter's inhibitory effects are enhanced by alcohol.
GABA
Blood glucose levels in HHS are typically greater than this value.
600 mg/dL
This is the most common cause of drug-induced acute liver failure
acetaminophen toxicity
This assessment scale is used to determine the severity of opioid withdrawal.
COWS (Clinical Opiate Withdrawal Scale)
Other than blood glucose, this should be evaluated before starting an insulin drip.
Potassium!
If K⁺ <3.3 → hold insulin and replace K⁺
If K⁺ ≥3.3 → start insulin
This should be administered in alcohol withdrawal to prevent development of Wernicke's encephalopathy.
Thiamine / vitamin B1
This is the most frequent trigger of HHS.
Infection
This medication can be used to reduce ammonia levels and treat hepatic encephalopathy.
lactulose
This characteristic odor may be noted on the breath of a patient with DKA.
Fruity breath
A family member asks what may have caused the patient's DKA. List some potential causes of this condition.
"4 S'": Skipped insulin (including new diagnosis), sepsis, stress, substances
This long-acting opioid agonist is used in structured treatment programs.
methadone
This is the priority intervention in treatment of HHS.
IV fluids
These laboratory values are commonly elevated in acute liver failure
Elevated liver enzymes (ALT/AST)
Hyperbilirubinemia
Prolonged PT/INR
Elevated ammonia
This is why it is especially important to monitor magnesium levels in withdrawal patients.
low Mg increases seizure risk
This is why it is important not to lower glucose levels too fast during treatment with IV insulin.
Lowering glucose too fast can drop serum osmolality → water shifts into brain cells → cerebral edema / increased ICP (especially in kids).
This severe complication of alcohol withdrawal typically occurs 48-72+ hours after the last drink.
Delirium tremens (DTs)
Severe confusion, agitation, & hallucinations, feve, severe hypertension and tachycardia, risk of cardiovascular and respiratory collapse
List some signs the nurse may look for when assessing a patient with HHS for dehydration.
dry mucous membranes, poor skin turgor, hypotension, tachycardia
List some signs that would cause the nurse to suspect development of hepatic encephalopathy.
Mild confusion/disorientation (early)
Altered mood
Personality changes
Drowsiness
Difficulty concentrating
Severe confusion (late)
Describe the process of osmotic diuresis in HHS.
This process occurs when glucose pulls water into the urine, causing significant fluid loss.
These are lab results that would support a diagnosis of DKA.
Glucose >/= 250 (typically)
UA positive for ketones
ABG results reflect metabolic acidosis
Elevated anion gap
At what point of opioid withdrawal treatment should buprenorphine / Suboxone be started?
Must start when moderate withdrawal begins
These are the findings that would support a diganosis of HHS.
Blood glucose >600 mg/dL
High serum osmolality
No or minimal ketones
No acidosis
Clinical presentation: S/S of severe dehydration, altered mental status
Describe hepatorenal syndrome.
Liver failure leads to renal vasoconstriction and decreased renal blood flow, resulting in renal injury.
Decreased U/O, Increased BUN & Creatinine, Edema
These are four functions of the liver.
Detoxification: Filters toxins from the blood, like drugs, alcohol, and metabolic waste (like ammonia)
Metabolism: Regulates glucose levels (glycogenolysis and gluconeogenesis), fat metabolism, and protein synthesis (albumin)
Synthesis of Coagulation Factors: Produces clotting factors essential for proper blood clotting (like fibrinogen and prothrombin).
Bile Production: Produces bile necessary for digestion and absorptions of fats