The discovery of insulin in 1921 changed the life expectancy of patients with diabetes. Hhns is an emergency caused by very high blood sugar, often over 600 mgdl. Seven of these were complicated by other illnesses. Longterm steroid use19 and gastroenteritis20 are common causes of hyperosmolar hyper glycemic state in children. Hyperosmolar nonketotic state hhs or coma happens in people with diabetes. 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. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. 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.
Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Hyperosmolar hyperglycemic state, diabetic hhs vs dka. Joint british diabetes societies jbds 2012 aug pdf, summary of report can be found in diabet med 2015 jun. Diabetes mellitus ketoacidosis hyperglycemic crisishyperosmolar state key points diabetic ketoacidosis and the hyperglycemic hyperosmolar state are potentially fatal hyperglycemic crises that occur as acute complications of uncontrolled diabetes mellitus. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs are potentially fatal hyperglycemic crises that occur as acute complications of uncontrolled diabetes mellitus.
Hyperosmolar hyperglycemic state hhs endocrine and. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. 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. It can develop over a course of weeks through a combination of illness e.
The condition most commonly occurs in people with type 2 diabetes. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Hyperosmolar hyperglycaemic state symptoms, diagnosis. Hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus. Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. 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. Changing the name to hyperosmolar hyperglycaemic state hhs allows for the fact that some people with severely raised blood glucose may. Hyperosmolar hyperglycemic state discharge care what. Hyperosmolar hyperglycemic state is treated much like diabetic ketoacidosis. Seven died, but in five death was probably not due to the hyperosmolar state. Risk calculators and risk factors for hyperosmolar hyperglycemic state. Diabetic ketoacidosis and hyperglycemic hyperosmolar. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome hhns.
Diabetic hyperosmolar syndrome symptoms and causes. Hyperosmolar hyperglycaemic state hhs occurs in people with type 2 diabetes who experience very high blood glucose levels often over 40mmoll. Hyperosmolar hyperglycemic state what you need to know. Management of the hyperosmolar hyperglycaemic state hhs. The management of the hyperosmolar hyperglycaemic state. 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. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Dka is more common in young people with type 1 diabetes and hhs in adult and elderly patients with type 2 diabetes.
How can you prevent hyperglycemic hyperosmolar nonketotic. Your body gets rid of the extra sugar through your urine. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Diabetic coma occurs when blood sugar gets too high and the body becomes severely dehydrated. However, hhs is different and treatment requires a different approach. Usually, people are given insulin intravenously so that it works quickly and the dose can be adjusted frequently. Diabetic emergencies ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. The level of glucose in the blood must be restored to normal gradually to avoid sudden shifts of fluid within the brain. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious and lifethreatening hyperglycemic emergencies in diabetes. Hyperosmolar hyperglycemic state american family physician. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis.
Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed. 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. The hyperosmolarity in this syndrome is due to either gross hyperglycemia or. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. The hyperglycemic hyperosmolar state hhs is a clinical syndrome characterized by increased blood glucose levels and serum osmolality. 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 hhs is a serious medical condition that develops if your blood sugar levels get very high. Hyperosmolar hyperglycemic state linkedin slideshare. Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. Although there are multiple precipitating causes, underlying infections are the most common. Twelve cases of diabetic hyperosmolar coma without ketosis are described in ten patients.
Hyperosmolar hyperglycemic state previously referred to as hyperglycemic hyperosmolar nonketotic coma hhnk and nonketotic hyperosmolar syndrome nkhs is a complication of type 2 diabetes mellitus and has an estimated mortality rate of up to 20%, which is significantly higher than the mortality for diabetic ketoacidosis currently diagnosis, and treatment diabetes care 2014. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. In one study18 of an urban population presenting with hyperos molar hyperglycemic state, the three leading causes were poor compliance with medica tion, ethanol ingestion, and cocaine use. Hyperosmolar hyperglycemic nonketotic syndrome hhns. Definitions dka consists of the biochemical triad of hyperglycemia, ketonemia and metabolic high anion gap acidosis the term hyperglycemic hyperosmolar nonketotic coma has been replaced with the term hyperglycemic hyperosmolar state hhs 1the hyperglycemic hyperosmolar state may consist of moderate to variable degrees of. Webmd tells you the symptoms to look out for and how its treated. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. 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. Hyperosmolar hyperglycemic state hhs, also known as nonketotic hyperglycemic hyperosmolar syndrome nkhs, is characterized by profound hyperglycemia glucose 600 mgdl, hyperosmolality effective serum osmolality. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. In both syndromes, there is insufficient insulin levels to transport. The management of hyperosmolar hyperglycaemic state hhs in adults with diabetes.
Features of the 2 disorders with ketoacidosis and hyperosmolality may coexist. Fluids and electrolytes must be replaced intravenously. Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine. Unlike the other common diabetes emergency, diabetic ketoacidosis dka, guidelines on the management of the hyperglycaemic hyperosmolar state hhs in adults are uncommon and often there is little to differentiate them from the management of dka. Hyperosmolar hyperglycemic state symptoms, diagnosis and. 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 nursing care plan for clients with diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome includes provision of information about disease processprognosis, selfcare, and treatment needs, monitoring and assistance of cardiovascular, pulmonary, renal, and central nervous system cns function, avoiding dehydration, and. Hyperosmolar hyperglycemic state winchester hospital. Hyperosmolar hyperglycemic state agency for clinical. 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 previously referred to as hyperglycemic hyperosmolar nonketotic coma hhnk and nonketotic hyperosmolar syndrome nkhs is a complication of type 2 diabetes mellitus and has an estimated mortality rate of up to 20%, which is significantly higher than the mortality for diabetic ketoacidosis currently nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33.