Hyperosmolar hyperglycemic nonketotic syndrome hhns. However, we think that special attention should be paid to particular points in the. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids with appropriate replacement of electrolytes primarily potassium. Extreme hyperglycemia and hyperosmolar hyperglycemic syndrome appel, susan j. Management of hyperglycemic hyperosmolar syndrome springerlink. Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction. This article is a chapter in the ispad clinical practice consensus. Conversely, dka or hyperosmolar coma might be the primary process here, resulting in electrolyte disturbances and subsequent vt 2. Hyperglycemic hyperosmolar syndrome is very rare in the pediatric population, but recent published reports suggest that the incidence of this disorder may be increasing. How does hyperosmolar hyperglycemic syndrome occur. Pdf the hyperosmolar hyperglycemic state hhs is the most. Start studying diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome.
Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed. Extreme hyperglycemia and hyperosmolar hyperglycemic syndrome. Causes are uti, pneumonia, sepsis, any acute illness, newly diagnosed type 2 diabetes. Dec 01, 2017 hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Diabetic ketoacidosis and hyperglycemic hyperosmolar. The pure hyperosmolar hyperglycemic syndrome, or hyperosmolar nonacidotic diabetes mellitus, is characterized by severe hyperglycemia, hyperosmolarity and dehydration in the absence of significant. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome management. Chronic hyperglycemia high blood sugar injures the heart in patients without a history of heart disease or diabetes and is strongly associated with heart attacks and death in subjects with no coronary heart disease or history of heart failure. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs.
Unlike dka, which can be diagnosed when blood glucose also called blood sugar values are in the range of 250300 mgdl over a few hours, hhs is diagnosed when blood. Oct 10, 2014 the hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis. Hyperglycemic hyperosmolar nonketotic syndrome hhs hhns. Diabetic ketoacidosis and hyperosmolar hyperglycemic state should be sus pected in people. 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 hhs endocrine and. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Pdf hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Understanding the presentation of hyperglycemic hyperosmolar nonketotic syndrome. Hyperosmolar hyperglycemic state is a lifethreatening emergency. The pure hyperosmolar hyperglycemic syndrome, or hyperosmolar nonacidotic diabetes mellitus, is characterized by severe hyperglycemia, hyperosmolarity and dehydration in the. Hyperglycemic hyperosmolar nonketotic syndrome hhns is an emergency that the diabetes mellitus dm patient may. Diabetic hyperosmolar syndrome diagnosis and treatment.
Hyperglycemic hyperosmolar nonketotic syndrome request pdf. The absence of ketoacidosis in the syndrome has been ascribed to both substrate free fatty acid deficiency and to interference with hepatic ketone body synthesis. Hyperglycemic hyperosmolar nonketotic coma1 pdf free. May 31, 2017 severe serum hyperosmolality, hyperglycemia, and dehydration without significant ketoacidosis define the hyperosmolar hyperglycemic syndrome. May 03, 2018 diabetic hyperosmolar syndrome is a medical emergency that you wont have time to prepare for. Diabetic hyperglycemic hyperosmolar syndrome hhs is a complication of type 2 diabetes. Sometimes undiagnosed diabetes results in diabetic hyperosmolar syndrome. 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. Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. Hyperglycemic hyperosmolar nonketotic syndrome is found mostly. It most often occurs in type 2 dm, often in the setting of physiologic stress.
The management of the hyperosmolar hyperglycaemic state hhs. Hyperosmolar hyperglycemic state american family physician. Myocardial infarction is also known to precipitate dka, which would explain hyperglycemia in this setting. Hyperosmolar hyperglycaemic state hhs is a diabetic emergency that although typically occurring in the elderly, is presenting in younger adults and teenagers, often as the initial presentation of type 2 diabetes mellitus t2dm. Although the diagnosis and treatment of diabetic ketoacidosis dka in adults and.
Calculating a corrected serum sodium can help quantify the degree of free water deficit. Diabetic ketoacidosis may be diagnosed when the combination of hyperglycemia high blood sugars, ketones in the blood or on urinalysis and acidosis are demonstrated. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. Appropriate treatment of hypernatraemia in diabetic. Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a consequence of the underlying precipitating causes rather. 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. What is hyperglycemic hyperosmolar nonketotic syndrome. Your risk of developing diabetic hyperosmolar syndrome might be higher if you. Hyperosmolar hyperglycemic state discharge care what you. Ketoacidosis and hyperosmolar hyperglycemia are the two most serious acute metabolic complications of diabetes, even if managed properly. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Your body gets rid of the extra sugar through your urine. It involves extremely high blood sugar glucose level without the presence of ketones. The goals of treatment are to provide frequent patient monitoring, to treat the underlying cause and to gradually and safely.
Management of the hyperosmolar hyperglycemic syndrome. Hhns can affect both types of diabetics, yet it usually occurs amongst people with type 2 diabetes usually, hhns is brought on by an illness or infection. 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 committee of the lawson wilkins pediatric endocrine society h yperglycemic hyperosmolar syndrome hhs, charac. Hyperosmolar hyperglycemic state clinical presentation. Hyperosmolar hyperglycemic syndrome occurs because as blood glucose levels go higher and higher, urine output goes up, and dehydration sets in. Hyperglycemic crises in patients with diabetes mellitus. Hyperosmolar hyperglycemic state diabetes care american. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
Hyperglycemia is a condition where blood sugar levels are increased. Hyperglycemic hyperosmolar syndrome hhs is a potentially life threatening condition involving extremely high blood sugar glucose levels when your blood sugar gets too high, the kidneys try. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome hhns. Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. The clinical features of the experimental hyperosmolar diabetic ehd rat model resemble those seen in the human syndromeextreme hyperglycemia without ketoacidosis is common to both. To be eligible for the study, patients had to have a. Hhs is precipitated by a stressor such as trauma, injury, or infection that increases insulin demand.
Treatment begins with intensive monitoring of the patient and laboratory. If you experience any of the following symptoms of the syndrome, seek em. To better understand risk factors for the development of diabetic hyperosmolar state dhs, we studied 5 patients with dhs and 5 agematched randomly selected diabetic controls admitted to two general hospitals during an 11year period. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome the two most common lifethreatening complications of diabetes mellitus include diabetic ketoacidosis dka and hyperglycemic hyperosmolar syndrome hhs. Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction in the net effective concentration of. Hyperglycemic hyperosmolar nonketotic syndrome medind.
An acute decompensated state in which patients manifest a change in mental status in the setting of hyperglycemia, hyperosmolarity and severe volume depletion. 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. Hyperglycemic hyperosmolar nonketotic syndrome hyperglycemic hyperosmolar nonketotic syndrome occurs at a frequency of 17. Hyperosmolar syndrome the two most common lifethreatening complications of diabetes mellitus include diabetic ketoacidosis dka and hyperglycemic hyperosmolar syndrome hhs.
Register for a free account existing user log in existing user log in. Specific laboratory values that support the diagnosis of hhs are plasma glucose 600 mgdl, arterial ph 7. The exact incidence of hhs is not known, but it is estimated to account for 320 mosmkg. A patient aged 62 with type ii diabetes of 5 years duration was recently admitted with severe hyperglycemia associated with hyperosmolar nonketotic syndrome, precipitated by the patient not taking his recommended antidiabetic treatment combination of glyburide plus metformin. Hyperglycemic emergencies in adults canadian journal of diabetes. Too much glucose in your blood also called hyperglycemia or high blood sugar can cause many problems. Predisposing factors for the diabetic hyperosmolar state. Phd, acnpbc, fnpbc, ccrn, faha, faanp the nurse practitioner. Extreme hyperglycemia and hyperosmolar hyperglycemic. I can never thank you enough for giving me a new life.
Hhns vs dka are two complications of diabetes mellitus. The hyperglycaemic hyperosmolar state hhs is a medical emergency. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids with appropriate replacement of electrolytes. Hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. Feb 17, 2019 hyperglycemic hyperosmolar nonketotic syndrome is an extremely serious complication that can lead to diabetic coma and even death in type 2 diabetes. Unlike the other common diabetes emergency, diabetic ketoacidosis dka, guidelines on the management of the hyperglycaemic hyperosmolar state hhs in adults are. What are the symptoms of hyperosmolar hyperglycemic syndrome. Hyperglycemic hyperosmolar nonketotic coma1 pdf free download. Diabetes mellitus a chronic disease characterized by all kinds of metabolic disorders, chiefly carbohydrate, caused by the absolute.
Arieff and carrolls diagnostic criteria included a blood glucose level. May 29, 2019 diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. 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 discharge care what. Hhs is different from diabetic ketoacidosis dka and treatment requires a different approach. Also, lifethreatening consequences of hyperglycemia is nonketotic hyperosmolar syndrome. Like diabetic ketoacidosis dka, hyperglycemic hyperosmolar syndrome hhs is a deadly and avoidable complication that is due to not having enough insulin for the present condition. I am on my way to a diabetes free life and i am happier than ever. The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis. The complete set of guidelines can be found for free download.
Hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Diabetic hyperosmolar syndrome symptoms and causes mayo. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. In about 10% of cases the blood sugar is not significantly elevated euglycemic diabetic ketoacidosis. The management of the hyperosmolar hyperglycaemic state. If you have symptoms of high blood sugar, such as extreme thirst and excessive urination, for a few days, check your blood sugar level and call your doctor for advice. If you dont monitor your blood sugar or you dont yet know you have type 2 diabetes, your risk is higher. Workup revealed a glucose level of 1904 mgdl, and hyperglycemic hyperosmolar syndrome was diagnosed. 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. Hyperosmolar hyperglycemic syndrome hhs can have lifethreatening symptoms.
Hyperglycemia is usually the first sign of diabetes mellitus. The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia. Hyperglycemic hyperosmolar nonketotic syndrome and diabetic ketoacidosis are two of the most serious acute complications of diabetes. Diabetic hyperosmolar syndrome is a medical emergency that you wont have time to prepare for. It is less common than the other acute complication of diabetes, diabetic ketoacidosis dka. Hyperosmolar nonketotic syndrome with hypernatremia. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. The mortality rate in patients with diabetic ketoacidosis dka is hyperosmolar hyperglycemic state hhs still remains high. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Diabetic hyperosmolar syndrome disease reference guide. These disorders can occur in both type 1 and type 2 diabetes.