Hyperosmolar Hyperglycemic Syndrome in a Very Older Patient Treated in Collaboration with Multiple Specialists: A Case Report

Abstract

A 97-year-old woman underwent open repair and immobilization of a right femoral metaphyseal fracture at our hospital. Owing to a postoperative cerebral infarction, enteral nutrition via a nasogastric tube was initiated. The patient subsequently developed hyperosmolar hyperglycemic syndrome (HHS) triggered by a urinary tract infection; she was unable to communicate and was referred to our department. In cooperation with a certified diabetes nurse and nutritionist, we adjusted the blood glucose levels and discontinued enteral nutrition. The patient’s level of consciousness improved, and she was able to talk with her family. We received useful advice from the diabetes-certified nurse (insulin dose and how to correct blood electrolyte levels) and nutritionist (when to start enteral feeding and increase caloric intake). Elderly patients often have multiple comorbidities, and the management of our patient was difficult because of the HHS. However, the patient was able to resume normal activities owing to the multidisciplinary collaboration in her treatment.