Hyperosmolar hyperglycemic state agency for clinical. This article is published with open access at abstract. Hyperosmolar hyperglycemic state hhs hhs and dka are of two of the most serious complications form diabetes hospital admissions for hhs are lower than the rate for dka and accounts for less than 1 percent of all primary diabetic admissions mortality rate for patients with hhs is between 10 and 20 percent, which is approximately 10 times higher than that for dka. Hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus. The management of the hyperosmolar hyperglycaemic state in. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing.
Hyperosmolar hyperglycemic state symptoms, diagnosis and. The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of. Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. It most often occurs in type 2 dm, often in the setting of physiologic stress.
Hyperosmolar hyperglycemic state hhs is 1 of 2 serious metabolic derangements that occurs in patients with diabetes mellitus dm and can be a lifethreatening emergency. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. Common complications of hhs are seen secondary to rapid correction of hyperglycemia.
Although dka and hhs are often discussed as separate entities, they represent points along a spectrum of hyperglycemic emergencies due to poorly controlled diabetes. Treatment of diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs. Diabetic ketoacidosis and hyperglycemic hyperosmolar. It is less common than the other acute complication of diabetes, diabetic ketoacidosis dka. Diabetic hyperosmolar syndrome symptoms and causes. Novel advances in the management of hyperglycemic crises uk versus usa ketan k. Hyperosmolar hyperglycemic state clinical presentation. In both syndromes, there is insufficient insulin levels to transport. The goals of treatment are to provide frequent patient monitoring, to treat the underlying cause and to gradually and safely. Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious and lifethreatening hyperglycemic emergencies in patients with diabetes. Target audience this educational activity has been designed to meet the educational needs of pharmacists and registered nurses involved in the management of patients with diabetes. Hyperosmolar hyperglycemic state, diabetic hhs vs dka.
Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. It is a lifethreatening emergency that, although less common than its counterpart, diabetic ketoacidosis dka, has a much higher mortality rate, reaching up to 510%. Hyperosmolar hyperglycemic state seen in type 2 diabetes mellitus more neurologic symptoms. Pdf hyperglycemic hyperosmolar syndrome hhs, which is characterized by marked elevations in serum glucose concentrations and hyperosmolality without. Purpose provide clinicians treating patients with diabetes the. Hyperosmolar hyperglycemic state diabetes care american.
Hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. Hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. Hyperosmolar hyperglycemic state hhs is the nomenclature recommended by the american diabetes association to emphasize the varying alterations in sensorium less than coma that are usually present in humans and that hhs may occur with mild ketosis and acidosis nugent, 2005. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Hyperosmolar hyperglycemic state hhshonc diabetic ketoacidosis adult diabetic ketoacidosis peds cerebral edema in dka.
Hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Hyperglycemia induced volume depletion without acidosis hyperosmolar hyperglycemic state hhsis an insidiously developing lifethreatening medical emergency. Insulin deficiency and high counterregulatory hormone concentrations also increase lipolysis and ketogenesis and. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. Diagnosis and treatment of diabetic ketoacidosis and the. Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a consequence of the underlying precipitating causes rather than a result of the metabolic. Treatment of diabetic ketoacidosis dkahyperglycemic. Diabetic ketoacidosis and hyperglycemic hyperosmolar state risk factors for dka in patients with known diabetes include insulin omission, poor metabolic control, previous episodes of dka, gastroenteritis with persistent vomiting and inability to maintain hydration.
Hyperosmolar hyperglycemic state american family physician. When your blood sugar gets too high, the kidneys try to. Patients are normally administered insulin during treatment of. Although the precipitating causes are numerous, underlying. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs, also known as hyperosmotic hyperglycemic nonketotic state hhnk are two of the most serious acute complications of diabetes. Hyperosmolar hyperglycaemic state symptoms, diagnosis. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Hyperosmolar hyperglycemic state hhs, also known as nonketotic hyperglycemic hyperosmolar syndrome nkhs, is characterized by profound hyperglycemia glucose 600 mgdl, hyperosmolality effective serum osmolality. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Like diabetic ketoacidosis, hyperosmolar hyperglycemic state syndrome is not a disease perse, but more of a consequence to another pathology that is associated with an increase in the levels of the counterregulatory hormones.
The management of the hyperosmolar hyperglycaemic state. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with. Changing the name to hyperosmolar hyperglycaemic state hhs allows for the fact that some people with severely raised blood glucose may also be mildly ketotic and acidotic. Pathophysiology of hyperosmolar hyperglycemic state. Hyperosmolar hyperglycemic state was previously known as diabetic coma. Hyperglycemic hyperosmolar syndrome used to be called honk hyperosmolar nonketotic dka and hhs absence of insulin increased glucagon increased diabetogenic hormones oxidation of free fatty acids ketones fuel source of glucose moa. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state. The management of the hyperosmolar hyperglycaemic state hhs. Management of diabetic ketoacidosis and hyperosmolar. Pdf the hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome the two most common lifethreatening complications of diabetes mellitus include diabetic ketoacidosis dka and hyperglycemic hyperosmolar syndrome hhs. Hyperosmolar hyperglycemic state what you need to know. Intravenous regular insulin is used to treat hyperglycemia. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus.
Your body gets rid of the extra sugar through your urine. Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. Neurologic abnormalities frequently present coma in 2550% of cases. Diabetic ketoacidosis is defined by a triad of hyper glycemia or a diagnosis of diabetes, metabolic acidosis, and ketonemia. Pathophysiological considerations and suggested guidelines for treatment phil zeitler, md, phd, andrea haqq, md, arlan rosenbloom, md, and nicole glaser, md for the drugs and therapeutics. Hyperglycemic hyperosmolar syndrome hhs is a potentially life threatening condition involving extremely high blood sugar glucose levels. The condition most commonly occurs in people with type 2 diabetes. Infection is the most common cause of hyperosmolar hyperglycemic state. Hospitalizations for hyperglycemic emergencies hyperglycemia, diabetic ketoacidosis, hyperosmolar hyperglycemic state were compared between new users of risperidone reference, and new users of. Hyperosmolar hyperglycaemic state hhs is a diabetic emergency that although. Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus dm characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness.
Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose, hyperosmolarity, and little or no ketosis. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. Title diabetic ketoacidosis versus hyperosmolar hyperglycemia state authored by lynn summers bsn, cen, lnc course no dkhh100208 contact hour 1 purpose the goal of this course is to describe diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. Hyperosmolar hyperglycemic state is a relatively common, lifethreatening endocrine emergency that is reported in all age groups,1 but it most frequently affects older patients with type 2 diabetes. Hyperosmolar hyperglycemic state hhs endocrine and. In brief diabetic ketoacidosis dka and hyperosmolar hyperglycemic syndrome hhs are two acute complications of diabetes that can result in increased morbidity and mortality if not efficiently and effectively treated.
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