Diabetic ketoacidosis and hyperosmolar hyperglycemic. The management of the hyperosmolar hyperglycaemic state. A committee of the ada has recommended replacing the previous name of this disorder hyperglycemic, hyperosmolar, nonketotic coma with the consensus term hyperglycemic hyperosmolar state. Elisaf, md, frsh c nonketotic hyperglycemic hyperosmolar syndrome hhs is found mostly in type 2 diabetic patients with marked hyperglycemia. The management of the hyperosmolar hyperglycaemic state hhs. Pediatric hyperglycemic hyperosmolar syndrome unc school of. Feb 03, 2020 hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. The criteria for hyperglycemic hyperosmolar state hhs include. Diabetic hyperosmolar syndrome is a condition that occurs when blood sugar levels are excessively high, causing blood to achieve a syrupy consistency. Buildup of ketones in the body ketoacidosis may also occur. Hyperosmolar hyperglycemic state linkedin slideshare. Diabetic hyperglycemic hyperosmolar syndrome hhs is a complication of type 2 diabetes.
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. Hyperglycemic hyperosmolar syndrome at the onset of type 2. Treatment of diabetic ketoacidosis dkahyperglycemic. Diabetic hyperosmolar syndrome diagnosis and treatment. But it is unusual and is often mild compared with diabetic ketoacidosis. Diabetic ketoacidosis and hyperglycemic hyperosmolar.
Hhns is an emergency caused by very high blood sugar, often over 600 mgdl. 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. Youll likely have blood and urine tests to measure your blood sugar level and kidney function and to detect infection, among other conditions. The condition most commonly occurs in people with type 2 diabetes. Hyperosmolar syndrome in a patient with uncontrolled diabetes. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome hhns. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Hyperglycemic hyperosmolar syndrome hhs, charac terized by extreme elevations in serum glucose concen trations and hyperosmolality without significant. If its not treated, diabetic hyperosmolar syndrome can lead to lifethreatening dehydration. Diabetic ketoacidosis is defined by a triad of hyper glycemia or a diagnosis of diabetes, metabolic acidosis, and ketonemia table 1. Identify important clinical or laboratory findings that are associated with hyperglycemic hyperosmolar coma in children. Diabetic hyperosmolar syndrome type 2 diabetes health monitor.
Hyperosmolar hyperglycemic state what you need to know. Nonketotic hyperosmolar syndrome nkhs consists of hyperglycemia, hyperosmolarity, severe dehydration and altered mental status without significant ketosis or acidosis. 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. 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. Diabetic hyperosmolar syndrome disease reference guide. Hyperosmolar hyperglycemic state hhs endocrine and. Hyperosmolar hyperglycemic state clinical presentation. 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.
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. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. Start studying hyperglycemia hyperosmolar nonketotic syndrome vs. Hyperglycemic hyperosmolar syndrome in children diabetes. Hyperosmolar hyperglycemic syndrome hhs is a clinical condition that arises from a complication of diabetes mellitus. The emergency medical team will do a physical and mental status exam and may ask those who are with you about your medical history. 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 pure hyperosmolar hyperglycemic syndrome, or hyperosmolar nonacidotic diabetes mellitus, is characterized by severe hyperglycemia, hyperosmolarity and dehydration in the absence of significant. The exact incidence of hhs is not known, but it is estimated to account for mar 01, 2010 hyperosmolar syndrome hos was diagnosed on the basis of hyperglycemia, hypernatremia, azotemia, high plasma osmolarity, and metabolic acidosis. 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 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. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. Nonketotic hyperosmolar hyperglycemic chorea scielo. Hyperglycemic hyperosmolar syndrome hhs is a potentially lifethreatening condition involving extremely high blood sugar, or glucose, levels. Hyperosmolar hyperglycemic nonketotic syndrome hhns. Diabetic hyperosmolar syndrome symptoms and causes. Pathophysiological considerations and suggested guidelines for treatment.
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. Treatment of diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs. The management of the hyperosmolar hyperglycaemic state in adults with diabetes. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing it into your urine. Novel advances in the management of hyperglycemic crises uk versus usa ketan k. May 03, 2018 diabetic hyperosmolar syndrome is a medical emergency that you wont have time to prepare for.
Use of a constant rate infusion of insulin for the treatment. Pdf hyperosmolar hyperglycaemic state hhs classically. 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, diabetic hhs vs dka. It is less common than the other acute complication of diabetes, diabetic ketoacidosis dka.
Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus. Your body gets rid of the extra sugar through your urine. Management of the hyperosmolar hyperglycemic syndrome.
It involves extremely high blood sugar glucose level without the presence of ketones. Hyperosmolar coma definition of hyperosmolar coma by. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. For diabetic hyperosmolar syndrome, prompt diagnosis is critical. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. What are the warning signs of hyperosmolar hyperglycemic nonketotic syndrome. Underlying renal insufficiency or congestive heart failure is common, and the presence of either worsens the prognosis. Hyperosmolar hyperglycemic state american family physician. Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Cerebral edema among adults with diabetic ketoacidosis and. Request pdf use of a constant rate infusion of insulin for the treatment of hyperglycemic, hypernatremic, hyperosmolar syndrome in an alpaca cria a 3dayold 9. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing.
Diabetic hyperosmolar syndrome symptoms and causes mayo. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Diabetic hyperosmolar syndrome is a serious condition caused by extremely high blood sugar levels. Hyperglycemic hyperosmolar state hhs is rare in the paediatric population. 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. Dec 01, 2017 hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus.
Hyperosmolar syndrome in a patient with uncontrolled diabetes mellitus haralampos j. However, cerebral oedema in the setting of dka or hyperglycaemic hyperosmolar syndrome hhs in adults is exceedingly rare, with a united states large populationbased study revealing a 0. Hyperosmolar nonketotic syndrome with hypernatremia. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Patients admitted to icu via ed with hhs hyperosmolar hyperglycemic. The diagnosis and management of hhs presents a challenge in paediatric. An acute decompensated state in which patients manifest a change in mental status in the setting of hyperglycemia, hyperosmolarity and severe volume depletion. Hhs is different from diabetic ketoacidosis dka and treatment requires a different approach. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Greco dvm, phd, diplomate acvim senior research scientist, nestle purina petcare st louis, mo diabetic ketoacidosis dka is the culmination of diabetes mellitus that results in unrestrained. Treatment and outcome a constant rate infusion of regular insulin was administered with hypoosmolar fluids to treat hos, and blood glucose and sodium concentrations were successfully lowered.
Hyperglycemic hyperosmolar nonketotic syndrome springerlink. The hyperglycaemic hyperosmolar state hhs is a medical emergency. Palladone, abilify also, two people in the lowcarbohydrate group died, one of complications from hyperosmolar coma at 5 months into the study and one of sudden severe. Pdf discuss the pathogenesis, presentation and management of. This article is published with open access at abstract. Hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. 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 oct 17, 2016 hyperglycemic hyperosmolar syndrome by. What are the warning signs of hyperosmolar hyperglycemic. The label carries a class warning that hyperglycemiasome times severe and associated with ketoacidosis or hyperosmolar coma or death has been reported in patients on atypicals. Oct 10, 2014 the hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis. Understanding the presentation of hyperglycemic hyperosmolar nonketotic syndrome hyperglycemic hyperosmolar nonketotic syndrome hhns is an emergency that.1555 715 1271 1340 565 25 421 702 1040 747 1033 1249 743 82 803 1413 309 968 45 49 928 1438 1295 779 1607 899 1263 605 286 1123 788 250 474 1481 376 770 357 1127 627 241 160 344 421 673 1371 908 395 994