Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in. So as we mentioned earlier, hyperosmolar hyperglycemic nonketotic state is a very serious, and potentially even lifethreatening complication of type 2 diabetes. Your body gets rid of the extra sugar through your urine. Hyperosmolar hyperglycemic state what you need to know. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels.
Hhns is an emergency caused by very high blood sugar, often over 600 mgdl. Hyperosmolar hyperglycemic state inpatient care what you. Hhs has been known by several other names in the past. Hhs is characterized by severe hyperglycemia, profound dehydration, and is often. Hhns is typically observed in elderly patients with noninsulindependent diabetes.
The incidence of diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome were 33. The name changed from honk hyperosmolar non ketotic coma to hyperosmolar hyperglycaemic state to allow for the fact that some patients may be extremely ill but not comatose and may also be mildly ketotic and acidotic. Traumatic brain injuries are the most frequent cause. Diabetic ketoacidosis and hyperglycemic hyperosmolar. Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine. Type 2 diab w hyprosm wo nonket hyprglyhypros coma nkhhc. This syndrome is characterised by severe hyperglycaemia, a marked increase in serum osmolality, and clinical evidence of dehydration without significant accumulation of ketoacids. What is hyperosmolar hyperglycemic nonketotic syndrome hhns. Hyperosmolar hyperglycemic nonketotic syndrome hhns is a complication of diabetes mellitus observed with high serum glucose, absence of ketone bodies and high hyperosmolarity. As, for examples, in hyperglycemic hyperosmolar syndrome and hyperosmolar coma.
These labels include hyperosmolar nonketotic coma, hyperosmolar hyperglycemic nonketotic coma, and hyperglycemic hyperosmolar nonketotic syndrome hackel, 2014. Hyperglycemic, hyperosmolar syndrome in feline diabetics. Mar 06, 2012 introduction hyperosmolar hyperglycemic state hhs and diabetic ketoacidosis dka represent two distinct metabolic derangements manifested by insulin deficiency and severe hyperglycemia dka is defined as the presence of all three of the following. 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. It is a condition in which the blood has a high concentration of salt sodium, glucose, and other substances. Diabetic hyperglycemic hyperosmolar syndrome hhs is a complication of type 2 diabetes. Hhs is different from diabetic ketoacidosis dka and treatment requires a different approach. The loss of water also makes the blood more concentrated than normal.
Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. Hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Hyperosmolar hyperglycemic nonketotic syndrome, or hhns, is a serious condition most frequently seen in older persons. We performed a historical cohort study of 39,628 renal transplantation. Hyperosmolar hyperglycemic state linkedin slideshare. 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 nonketotic syndrome as firstlisted diagnosis total events crude rate per 1,000 95% confidence interval lower limit. Hyperosmolar hyperglycemic state is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes.
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 lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. The main risk factor is a history of diabetes mellitus type. 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 hyperosmolar nonketotic syndrome vs. In biochemistry, pertaining to an osmolar concentration of the body fluids that is abnormally increased. Acute complications of diabetes hyperosmolar hyperglycemic.
The hyperglycaemic hyperosmolar state hhs is a medical emergency. Evaluation at presentation revealed profound dehydration, lactic acidosis, and azotemia. 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 hyperosmolar hyperglycemic nonketotic syndrome hhns. 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 250 mgdl, ii ketosis, and iii acidemia ph pdf hyperosmolar hyperglycemic nonketotic syndrome, or hhns, is a serious condition most frequently seen in older persons. Hyperosmolar hyperglycemic state hhs endocrine and. Hyperglycemia hyperosmolar non ketotic coma ppt xpowerpoint. Jan 19, 2019 hyperosmolar hyperglycemic nonketotic syndrome, or hhns, is a serious condition most frequently seen in older persons. The first step of treatment involves careful monitoring. The incidence and risk factors for diabetic ketoacidosis diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome hyperglycemic hyperosmolar syndrome, previously called nonketotic hyperosmolar coma have not been reported in a national population of renal transplant renal transplantation recipients. Full text get a printable copy pdf file of the complete article 907k, or click on a page image below to browse page by page. The management of the hyperosmolar hyperglycaemic state. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. Intravenous fluid replacement is similar to that administered in diabetic ketoacidosis dka and. Hyperosmolar hyperglycemic state on the web most recent articles.
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%. Diabetic hyperglycemic hyperosmolar syndrome multimedia. Find powerpoint presentations and slides using the power of, find free presentations research about hyperglycemia hyperosmolar non ketotic coma ppt. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis.
Hyperosmolar nonketotic coma definition of hyperosmolar. Complications may include seizures, disseminated intravascular coagulopathy, mesenteric artery occlusion, or rhabdomyolysis. Diabetic ketoacidosis and hyperosmolar hyperglycemic state. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Hyperosmolar hyperglycemic nonketotic syndrome and.
Five cases are described, in all of which excessive consumption of lucozade, a proprietary glucose drink, played an important part in the development of their hyperosmolar state. Assistant professor of medicine, ucla medical center. Mortality of hyperglycemic crisis dka is the most common cause of death in children and adolescents with type 1 diabetes. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs, also called hyperosmotic hyperglycemic nonketotic state hhnk are two of the most serious acute complications of diabetes. Diabetic emergencies ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Hyperosmolar hyperglycemic nonketotic syndrome hhns. Hyperglycemic hyperosmolar state hhs is an acute complication associated with diabetes mellitus. Joint british diabetes societies jbds 2012 aug pdf, summary of report can be found in diabet med 2015 jun. Pdf hyperosmolar hyperglycemic nonketotic syndrome in a. Diabetic hyperosmolar syndrome symptoms and causes mayo. Disease and disorder list organ transplantations sarcoidosis neurology deliriumdementia encephalopathy meningitisencephalitis myopathy neoplasmmalignancies paraplegiaquadriplegia peripheral neuropathy seizure disorders stroke ischemic hemorrhagic psychiatry mood disorders psychosis substance use disorders suicideoverdose.
Client concerns included polydipsia, polyuria, and lethargy. 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. Oct 27, 2012 hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. Hyperglycemic, hyperosmolar syndrome was seen in older cats that were often long. The condition most commonly occurs in people with type 2 diabetes. And as such, any individual with type 2 diabetes who becomes very ill over a period of days to weeks should really be taken to the emergency room immediately to be evaluated for hhns. Research and education associate, wadsworth general hospital and cedars. As mentioned in the previous article, the diabetic related comas listed in order of their probable frequency are 1 hypoglycaemia coma 2 diabetic ketoacidosis 3 hyperglycaemic hyperosmolar nonketotic coma.
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. Hhns can happen to people with either type 1 or type 2 diabetes, but it occurs more often in people with type 2. Management of the hyperosmolar hyperglycemic syndrome. View and download powerpoint presentations on hyperglycemia hyperosmolar non ketotic coma ppt. It involves extremely high blood sugar glucose level without the presence of ketones. They each represent an extreme in the hyperglycemic spectrum. In 2010, among adults aged 20 years or older, hyperglycemic crisis caused 2,361 deaths in the u. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva ada american diabetes association. Patients with hyperosmolar hyperglycemic syndrome are often chronically ill, and they may have major total body deficits of potassium, phosphate and magnesium, as well as bcomplex vitamins. Dka is characterized by ketoacidosis and hyperglycemia, while hhs usually has more severe hyperglycemia but no ketoacidosis table 1.
Feb 03, 2020 hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are the two most serious metabolic complications of diabetes mellitus dm. The primary goal of treatment in hyperglycemic hyperosmolar nonketotic syndrome hhns is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Complications may include seizures, disseminated intravascular coagulopathy. Treatment of hyperglycaemic hyperosmolar nonketotic syndrome. Mar 22, 2006 diabetic ketoacidosis and hyperosmolar hyperglycemic state. Hyperosmolarity without nonketotic hyperglycemic hyperosmolar coma due to type 2 diabetes mellitus icd10cm diagnosis code e11. Hyperosmolar syndrome or diabetic hyperosmolar syndrome is a medical emergency caused by a very high blood glucose level the prefix hyper means high, and osmolarity is a measure of the concentration of active particles in a solution, so the name of the syndrome simply refers to the high concentration of glucose in the blood.
Neurologic and respiratory signs occurred frequently. Hyperosmolar hyperglycemic state inpatient care what. This draws the water out of the bodys other organs, including the brain. If you continue browsing the site, you agree to the use of cookies on this website. Usually, hhns is brought on by an illness or infection. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing. Dec 10, 2018 hyperosmolar hyperglycemic nonketotic syndrome hhns mostly affects elderly people. The mortality rate from hhs is significantly higher than for dka. 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 hhs is a potentially life threatening condition involving extremely high blood sugar glucose levels when your blood sugar gets too high, the kidneys try. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus t2 dm and its incidence is likely to go up, given global increase in incidence of childhood obesity, increased insulin resistance, and t2 dm. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Arieff and carrolls diagnostic criteria included a blood glucose level.