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©2013 UpToDate ® Print Email Protocol for the management of adult patients with HHS HHS diagnostic criteria: serum glucose >600 mg/dl, arterial pH >7.3, serum bicarbonate >15 mEq/l, and minimal ketonuria and ketonemia. Normal laboratory values vary; check local lab normal ranges for all electrolytes. IV: intravenous; SC: subcutaneous. * After history and physical exam, obtain capillary glucose and serum or urine ketones (nitroprusside method). Begin one liter of 0.9 percent NaCl over one hour and draw arterial blood gases, complete blood count with differential, urinalysis, serum glucose, BUN, electrolytes, chemistry profile and creatinine levels STAT. Obtain electrocardiogram, chest X-ray, and specimens for bacterial cultures, as needed. • Serum Na + should be corrected for hyperglycemia (for each 100 mg/dl glucose >100 mg/dl, add 1.6 mEq to sodium value for corrected serum sodium value). Δ An alternative IV insulin regimen is to give a continuous intravenous infusion of regular insulin at 0.14 units/kg per hour; at this dose, an initial intravenous bolus is not necessary. Copyright © 2006 American Diabetes Association From Diabetes Care Vol 29, Issue 12, 2006. Modifications from Diabetes Care Vol 32, Issue 7, 2009. Reprinted with permission from the American Diabetes Association.