Advanced Medical Life Support (AMLS)

What is the initial treatment for hyperosmolar hyperglycemic nonketotic coma (HHNC)?

1. Crystalloid IV fluid administration

2. Administration of dextrose

3. Administration of insulin

4. Fluid bolus of 5% dextrose in water (D5W)

The correct answer is: Crystalloid IV fluid administration

In the management of hyperosmolar hyperglycemic nonketotic coma (HHNC), the initial treatment focuses on correcting the dehydration and electrolyte imbalances that are characteristic of this condition. The most appropriate first step is the administration of crystalloid IV fluids. Crystalloids, such as normal saline or lactated Ringer's solution, are crucial as they help restore intravascular volume, improve perfusion to vital organs, and dilute the elevated serum osmolality. Patients in HHNC often present with significant hyperglycemia and osmotic diuresis, leading to severe dehydration. It is essential to adequately hydrate these patients before other interventions, like insulin therapy, are introduced. While insulin administration is an ultimately necessary part of treatment to lower blood glucose levels over time, initiating treatment with insulin before sufficient fluid resuscitation can result in further dehydration and potential complications. Therefore, the emphasis on initial fluid resuscitation with crystalloids is a cornerstone of the management protocol for HHNC.