The management of the hyperosmolar hyperglycaemic state in. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are. Allan b, dhatariya k, flanagan d, hammersley m, hillson r, james j, mcknight j, malik r, rayman g, richie k, roberts a, sampson m, savage m, stanisstreet d. 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 management of hyperosmolar hyperglycaemic state. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently.
Jun 24, 2019 hyperglycemic hyperosmolar nonketotic syndrome hhns is a potentially deadly condition that can develop as a result of infection or illness in people with uncontrolled type 2 diabetes or when diabetes medications arent taken as directed. Diabetic hyperosmolar syndrome is a medical emergency that you wont have time to prepare for. Hyperglycemic hyperosmolar state in an adolescent with. Hyperosmolar hyperglycemic state causes, symptoms, treatment. Hyperosmolar hyperglycemic state hhs endocrine and.
Jan 14, 2019 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. Dka is more common in young people with type 1 diabetes and hhs in adult and elderly patients with type 2 diabetes. The management of the hyperosmolar hyperglycaemic state hhs in adults with diabetes. Your body gets rid of the extra sugar through your urine. Hyperglycemic hyperosmolar states hhs hhs is a vicious cycle of high sugars that lead to excessive urination and dehydration. If you have type 1, you may not have given yourself enough insulin. It can also happen if the diabetes treatment plan is not followed. Ketoacidosis and hyperosmolar hyperglycemia are the two most serious acute metabolic complications of diabetes, even if managed properly. Hyperosmolar hyperglycemic state inpatient care what you. Download adobe acrobat or click here to download the pdf. The management of the hyperosmolar hyperglycaemic state hhs. An american diabetes association consensus statement represents the.
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. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome the two most common lifethreatening complications of diabetes mellitus include diabetic ketoacidosis dka and hyperglycemic hyperosmolar syndrome hhs. This article is published with open access at abstract. However, with hyperosmolar hyperglycemic state, the blood glucose levels can become extremely high even exceeding 1,000 milligrams per deciliter mgdl, or 55.
Hhs is characterized by severe hyperglycemia and hyperosmolality without significant ketosis and acidosis. A 14yearold japanese boy presented at the emergency room with lethargy, polyuria and polydipsia. Hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. Hyperosmolar hyperglycaemic state hhs occurs in people with type 2 diabetes who experience very high blood glucose levels often over 40mmoll. Appropriate individualized acute management of these conditions typically results in satisfactory clinical outcomes and may decrease the mortality rate from up to 20% in type 2 diabetics with hyperglycemic hyperosmolar state vs less than 2% in patients with dka. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. The anesthetic management of labor and delivery as well as operative deliveries will be discussed. Hyperglycemic hyperosmolar state hyperglycemia dehydration. Symptoms of this state can include increased urination, increased. Hyperosmolar hyperglycemic nonketotic syndrome hhns. Treatment of diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs.
According to the diabetes surveillance system of the centers for disease control and prevention cdc, overall, ageadjusted dka hospitalization rates decreased slightly from 2000 to 2009. Oct 10, 2014 the hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. The person with hhs is often elderly, frequently with multiple comorbidities but always very sick. The dehydration causes the blood to become more concentrated and the blood sugar to rise even more. Contributes to less than 1% of all diabetesrelated admissions.
Diabetologia by the american diabetes association and the european. A hyperglycemic hyperosmolar state hhs is a condition that results from having an elevated blood glucose level, typically as a result of having uncontrolled diabetes mellitus, which is a condition in which the body cannot regulate the concentration of glucose in the blood. Joint british diabetes societies jbds for inpatient care. Hyperosmolar nonketotic state hhs or coma happens in people with diabetes.
Occurs most commonly in older patients with type 2 diabetes. Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction. 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. Treatment of diabetic ketoacidosis dkahyperglycemic.
Hyperosmolar hyperglycemic state is treated much like diabetic ketoacidosis. 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. Feb 03, 2020 hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Mar 31, 2017 diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are diabetic emergencies that cause high morbidity and mortality. 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. Hyperglycemic hyperosmolar nonketotic syndrome is an extremely serious complication that can lead to diabetic coma and even death in type 2 diabetes. Hyperosmolar hyperglycemic state hhs is a serious complication of diabetes characterized by serum hyperglycemia and hyperosmolarity, without ketoacidosis. Fisher, md 1 d iabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhsarethetwomostseriousacute. Hyperosmolar hyperglycaemic state symptoms, diagnosis. Dec 15, 20 according to the consensus statement published by the american diabetes association, diagnostic features of hhs may include the following. If you feel the symptoms of extreme high blood sugar, call 911 or your local. However, hhs is different and treatment requires a different approach.
Unlike the other common diabetes emergency, diabetic ketoacidosis dka, guidelines on the management of hyperglycaemic hyperosmolar state hhs in adults are uncommon and often there is little to differentiate them from the management of. Hyperglycemic crises in adult patients with diabetes abbas e. Hyperglycemia high blood sugar causes too much food illness not enough insulin infection decreased activity stress symptoms thirst frequent urination fatigue blurred vision nausea action necessary check blood glucose check urine for ketones glucose 300 mgdl or level set in diabetes care plan. Fluids and electrolytes must be replaced intravenously. 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. A normal or mildly elevated blood glucose level does not rule out diabetic ketoacidosis in certain conditions, such as pregnancy or with sglt2 inhibitor use. The american diabetes association classifies dka by severity as mild. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. The management of the hyperosmolar hyperglycaemic state. 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. Dka is more common in young hyperosmolar hyperglycemic state hhs most commonly develops in individuals older than 65 years.
Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. It is less common than the other acute complication of diabetes, diabetic ketoacidosis dka. Hyperosmolar hyperglycemic state clinical presentation. High blood sugar happens when the body has too little insulin or when the body cant use insulin properly. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes. Strategies for medical management that are safe for both mother and fetus will be presented. It can develop over a course of weeks through a combination of illness e. Hyperosmolar hyperglycemic state winchester hospital. Hyperosmolar hyperglycemic state american family physician. Management of hyperosmolar hyperglycaemic state in adults.
Hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. Ketoacidosis and the hyperglycemic hyperosmolar state adam bursua, pharm. Hyperosmolar hyperglycemic state linkedin slideshare. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. Hyperosmolar hyperglycaemic state linkedin slideshare. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. The most common precipitating causes of dka reported in different epidemiological studies worldwide are shown in table 1.
This conditionand the enormous dehydration that accompanies itoccurs most often in older persons with type 2 diabetes. What hypoglycemia is, the symptoms, treatment, and what to do when it is severe. Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious and lifethreatening hyperglycemic emergencies in diabetes. Hyperglycemic crises in adult patients with diabetes. Reprinted with permission of the american diabetes association. Hyperosmolar hyperglycemic state what you need to know. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. What is hyperglycemic hyperosmolar nonketotic syndrome. The ada says the annual rate for dka ranges from 4.
Hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. The joint british diabetes societies for inpatient care have recently provided guidance on the management of hyperosmolar hyperglycaemic state hhs, a medical emergency which differs from diabetic ketoacidosis dka through higher mortality and potential for complication by myocardial infarction, stroke, seizures, cerebral oedema and central. 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. 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. If you have type 2, your body may have enough insulin. Hyperglycemia is the technical term for high blood glucose blood sugar. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most. 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 may 04, 2020 pasquel fj, umpierrez ge. Presents with polyuria, polydipsia, weakness, weight loss, tachycardia, dry mucus membranes, poor skin turgor, hypotension, and, 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.
According to the american diabetes association ada, while dka has a death rate of less than 5%, that figure can reach around 15% for hhs. Diabetic ketoacidosis and hyperglycemic hyperosmolar. Very high blood glucose levels often over 40 mmoll develop as a result of a combination of illness, dehydration and an inability to take normal diabetes medication due to the effect of illness. According to the consensus statement published by the american diabetes association, diagnostic features of hhs may include the following. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. Features of the 2 disorders with ketoacidosis and hyperosmolality may coexist. Diabetic ketoacidosis and hyperosmolar hyperglycemic state are medical emergencies that require treatment and monitoring for multiple metabolic abnormalities and vigilance for complications. State university, spokane, wa, usa, kamlesh khunti university of. It appears your web browser is not configured to display pdf files. The exact incidence of hhs is not known, but it is estimated to account for oct 06, 2017 nonetheless, hhs can be deadly. Based on the 2009 american diabetes association publication. The mortality rate in patients with diabetic ketoacidosis dka is emergencies. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. Dec 23, 2015 hyperosmolar hyperglycaemic state hhs occurs in people with type 2 diabetes.
Hyperosmolar hyperglycemic state hhs the johns hopkins. Novel advances in the management of hyperglycemic crises uk versus usa ketan k. Largescale studies to determine optimal management of dka and hhs are lacking. Diabetic hyperosmolar syndrome disease reference guide. Type two diabetics enter a state of such high blood sugar that osmosis bring water from the cells into the extraceullar space and the patient becomes extremely dehydrated. Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a consequence of the underlying precipitating causes rather. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. Hyperglycemic hyperosmolar states diabetes education online.
Objectives describe the epidemiology of diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs differentiate between dka and hhs. Usually, people are given insulin intravenously so that it works quickly and the dose can be adjusted frequently. 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%. Dka is the initial presentation of diabetes in 15% to 20% of adults and in 30 to 40% of children with t1d 4,37,38.
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. What are the ada diagnostic criteria for hyperosmolar. Hyperglycemic hyperosmolar state free download as powerpoint presentation. The joint british diabetes societies for inpatient care have recently provided guidance on the management of hyperosmolar hyperglycaemic state hhs, a medical emergency which differs from diabetic ketoacidosis dka through higher mortality and potential for complication by myocardial infarction, stroke, seizures, cerebral oedema and central pontine myelinolysis the latter possibly. Hyperosmolar hyperglycemic state how to manage your. Hyperosmolar hyperglycemic state can affect both type 1 and type 2 diabetes, yet it usually occurs amongst people with type 2 diabetes. Infection is the most common cause of dka around the world. Because people with type 2 diabetes produce some insulin, ketoacidosis does not usually develop even when type 2 diabetes is untreated for a long time. Hyperosmolar hyperglycemic state bmj best practice. The level of glucose in the blood must be restored to normal gradually to avoid sudden shifts of fluid within the brain. Introduction life threatening emergency less severe than dka previously known as hhnkc infection is the most common precipitating factor characterised by hyperglycaemia hyperosmolar dehydration without ketoacidosis. 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. Underlying renal insufficiency or congestive heart failure is common, and the presence of either worsens the prognosis.
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