The level of glucose in the blood must be restored to normal gradually to avoid sudden shifts of fluid within the brain. 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 hyperglycemia in which fluid intake is inadequate to prevent extreme dehydration due to the. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. What are the ada diagnostic criteria for hyperosmolar. Treatment of diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs. What is hyperglycemic hyperosmolar nonketotic syndrome. The management of the hyperosmolar hyperglycaemic state in. Patients admitted to icu via ed with hhs hyperosmolar hyperglycemic. Although there are multiple precipitating causes, underlying infections are the most common. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious acute metabolic emergencies in type 1 and type 2 diabetes. It most often occurs in type 2 dm, often in the setting of physiologic stress. C 32 physicians should work with the patient, family, and caregivers to help prevent future occurrences. The management of the hyperosmolar hyperglycaemic state.
Hyperosmolar hyperglycemic state hhs the johns hopkins. Overview of the diabetic ketoacidosis dka hyperglycemic. Hyperosmolar hyperglycemic state is treated much like diabetic ketoacidosis. Hyperosmolar hyperglycemic nonketotic syndrome, or hhns, is a serious condition most frequently seen in older persons. 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. Usually, people are given insulin intravenously so that it works quickly and the dose can be adjusted frequently. An american diabetes association consensus statement represents the. Although typically occurring in the elderly, hhs is presenting in ever younger adults and teenagers, often as the initial presentation of type 2 diabetes mellitus t2dm. Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus dm characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness.
Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus predominantly type 2 in which high blood sugars cause severe dehydration, increases in osmolarity relative concentration of solute and a high risk of complications, coma and death. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. Diabetic ketoacidosis is defined by a triad of hyper glycemia or a diagnosis of diabetes, metabolic acidosis, and ketonemia. Diabetic ketoacidosis and hyperosmolar hyperglycemic.
Novel advances in the management of hyperglycemic crises uk versus usa ketan k. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva ada american diabetes association. On the basis of the consensus statement published by the american diabetes association, diagnostic features of hyperosmolar hyperglycemic state hhs may include the followingref6ref8. Ar scott 1 on behalf of the joint british diabetes societies for inpatient care 2 and the joint british diabetes societies hyperosmolar hyperglycaemic state guidelines group 3. A consensus statement from the international society for pediatric and adolescent diabetes. D iabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are acute and potentially lifethreatening complications of diabetes. Hyperosmolar hyperglycemic state ambulatory care what. Pdf the hyperosmolar hyperglycemic state hhs is the most serious. While the ada guidelines acknowledge that approximately 10% of patients with dka present with lower glucose levels, they emphasize that. 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. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are.
This conditionand the enormous dehydration that accompanies itoccurs most often in. 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. The management of the hyperosmolar hyperglycaemic state hhs. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. Neurologic abnormalities frequently present coma in 2550% of cases. 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.
Test them regularly using a glucometer, work with your doctor to make sure youre taking any diabetes medications as prescribed, and learn the warning signs of elevated glucose levels and dehydration, such as extreme thirst and frequent urination, so you know to seek treatment when you need it. Adapted with permission from kitabchi ae, umpierrez ge, murphy mb, et al american diabetes association. When your blood sugar gets too high, the kidneys try to. Although they have important differences, they both occur because of lack of insulin effect and can be considered two manifestations of the same underlying mechanism. The best way to prevent hhns is by keeping your blood sugar levels under control. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Hyperosmolar hyperglycemic state hhs endocrine and. 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.
Treatment of diabetic ketoacidosis dkahyperglycemic. The hyperglycaemic hyperosmolar state hhs is a medical emergency. 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. It can develop over a course of weeks through a combination of illness e.
Hhs is different from diabetic ketoacidosis dka and treatment requires a different approach. Hyperosmolar hyperglycaemic state hhs is a diabetic emergency that. Severely uncontrolled type 2 diabetes, usually over a relatively short period of time, can lead to a dangerous rise in blood glucose known as hyperosmolar hyperglycemic state, or hhs. Hyperglycemic hyperosmolar syndrome hhs is a potentially life threatening condition involving extremely high blood sugar glucose levels. Diabetic ketoacidosis and hyperglycemic hyperosmolar. Hyperosmolar hyperglycemic state hhshonc diabetic ketoacidosis adult diabetic ketoacidosis peds cerebral edema in dka. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs, also known as hyperosmotic hyperglycemic typical lab characteristics of dka and hhs ada dka hhs water deficit dka rapid overview hyperglycemic crises in adult patients with diabetes. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. Reprinted with permission of the american diabetes association. Hyperglycemic crises in adult patients with diabetes. Hyperosmolar hyperglycemic state american family physician.
Reprinted with permission of the american diabetes association table 1 losses of fluid and electrolytes in diabetic ketoacidosis and maintenance requirements in normal children. Fluids and electrolytes must be replaced intravenously. Typically, patients with type 1 diabetes are more likely to exhibit. Diabetes increases your risk for many serious health problems. 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. Pdf diabetic ketoacidosis dka and the hyperosmolar. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of. Diabetic ketoacidosis and hyperglycemic hyperosmolar state wolfsdorf ji, allgrove j, craig me, edge j, glaser n, jain v, lee wwr, mungai lnw, rosenbloom al, sperling ma, hanas r.
Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. The hyperosmolar hyperglycemic state hhs is the most serious acute hypergly cemic emergency in patients with type 2 diabetes. To prevent these serious and sometimes life threatening conditions, it is important to follow the precautions below. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum.
Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. The goals of treatment are to provide frequent patient monitoring, to treat the underlying cause and to gradually and safely. Overview of the diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs episode of care 1. The hyperosmolar hyperglycemic state hhs is rare case and the most serious acute hyperglycemic emergency in patients with type 2 diabetes, are characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently.
Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. Changing the name to hyperosmolar hyperglycaemic state hhs allows for the fact that some people with severely raised blood glucose may. View the article pdf and any associated supplements and figures for a period of 48 hours. This article is published with open access at abstract. Hyperosmolar hyperglycemic state what you need to know. 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.
The criteria for hyperglycemic hyperosmolar state hhs include. Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the in fact, the. Your body gets rid of the extra sugar through your urine. With the correct treatment and recommended lifestyle changes, many people with diabetes are able to prevent or delay the onset of complications.
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