Oct 31, 2017 hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus. Cerebral edema among adults with diabetic ketoacidosis and. How is hyperosmolar hyperglycemic syndrome hhs diagnosed. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. Takanobu hirosawa, md and taro shimizu, md, mph, mba. Diabetic ketoacidosis and hyperosmolar hyperglycemic. 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.
Hyperosmolar hyperglycemic state american family physician. Hyperosmolar hyperglycemic state clinical presentation. Understanding the presentation of hyperglycemic hyperosmolar. 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 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. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs. Dec 23, 2015 hyperosmolar hyperglycaemic state hhs occurs in people with type 2 diabetes. The management of the hyperosmolar hyperglycaemic state. Its considered an acute exacerbation of type 2 diabetes mellitus. 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 hyperosmolar syndrome disease reference guide. It most often occurs in type 2 dm, often in the setting of physiologic stress. The exact incidence of hhs is not known, but it is estimated to account for hyperosmolar hyperglycemic state hhs, also known as nonketotic hyperglycemic hyperosmolar syndrome nkhs, is characterized by profound hyperglycemia glucose 600 mgdl, hyperosmolality effective serum osmolality. The management of the hyperosmolar hyperglycaemic state hhs.
What is hyperglycemic hyperosmolar nonketotic syndrome. The criteria for hyperglycemic hyperosmolar state hhs include. Diabetic hyperosmolar syndrome diagnosis and treatment. In 3040% of cases, hhs is the patients initial presentation of diabetes.
Overview diagnosis and tests management and treatment prevention outlook prognosis living with. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. 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. 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. Inthere were reportedemergency department visits with a diagnosis of hyperglycemic crisis 7. Diabetic hyperosmolar syndrome is a medical emergency that you wont have time to prepare for. Hyperosmolar hyperglycemic state hhs, also known as nonketotic hyperglycemic hyperosmolar syndrome nkhs, is characterized by profound hyperglycemia glucose 600 mgdl, hyperosmolality effective serum osmolality. The pure hyperosmolar hyperglycemic syndrome, or hyperosmolar nonacidotic diabetes mellitus, is characterized by severe hyperglycemia, hyperosmolarity and dehydration in the absence of significant. Diabetic hyperosmolar syndrome symptoms and causes. Dehydration can then lead to a drop in blood pressure, which can alter the individuals state of consciousness. 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 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. 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. Answer hyperglycemic hyperosmolar nonketotic syndrome occurs when the blood sugar gets too high and the body becomes severely dehydrated. The incidence of dka in the us continues to increase and it accounted for abouthospitalizations in figure cises and, most recently, in forhospitalizations 34. This is a state of severe hyperglycemia, except without ketoacidosis.
Hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. See also diabetes mellitus and complications of diabetes mellitus. Hyperglycemic hyperosmolar syndrome in children diabetes. So that gives us a bit of a hint as to whats going on, right. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome management. If you feel the symptoms of extreme high blood sugar, call 911 or your local. Hyperosmolar hyperglycemic state hyperosmolar hyperglycemic state occurs when hyperglycemia is high, often greater than 30 mmoll, leading to severe dehydration due to the frequency and volume of urination. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. May 03, 2018 diabetic hyperosmolar syndrome is a medical emergency that you wont have time to prepare for. The hyperglycaemic hyperosmolar state hhs is a medical emergency. 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.
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. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Hyperglycemic hyperosmolar nonketotic syndrome request pdf. 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. 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.
The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. What is hyperosmolar hyperglycemic nonketotic syndrome hhns. Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction. Hyperosmolar nonketotic diabetic syndrome following treatment of human immunodeficiency virus infec tion with didanosine. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Left untreated, diabetic hyperosmolar syndrome can lead to lifethreatening dehydration. The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis. 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. May 29, 2019 diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. The diagnosis and management of hhs presents a challenge in paediatric patients who may present with a mixed picture of hhs and diabetic ketoacidosis dka. Hyperosmolar hyperglycemic nonketotic syndrome how to. Hyperosmolar hyperglycemic nonketotic syndrome hhns. 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%.
Hyperosmolar hyperglycemic state symptoms, diagnosis and. Remember that the cell has two options for getting energy. Osmotic demyelination syndrome due to hyperosmolar hyperglycemia. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of. 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. Hyperglycemic hyperosmolar nonketotic syndrome and diabetic ketoacidosis are two of the most serious acute complications of diabetes. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Your body gets rid of the extra sugar through your urine. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Hyperglycemic hyperosmolar state hhs is rare in the paediatric population.
Hyperglycemic hyperosmolar nonketotic syndrome hhns is an emergency that the diabetes mellitus dm patient may. List of causes of hyperglycemic hyperosmolar nonketotic syndrome. Diabetic hyperglycemic hyperosmolar syndrome hhs is a complication of type 2 diabetes. Hyperglycemic hyperosmolar syndrome at the onset of type 2. To illustrate the importance of a quantitative analysis in the clinical management of patients with dka and hyperglycemic hyperosmolar syndrome. 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 state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Following is a list of causes or underlying conditions see also misdiagnosis of underlying causes of hyperglycemic hyperosmolar nonketotic syndrome that could possibly cause hyperglycemic hyperosmolar nonketotic syndrome includes. Hyperglycemic hyperosmolar nonketotic syndrome is found mostly. Jan 14, 2019 most patients with hyperosmolar hyperglycemic state hhs have a known history of type 2 dm. Hyperosmolar hyperglycemic state hhs endocrine and. Dec 01, 2017 hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. Diabetic ketoacidosis and hyperglycemic hyperosmolar.
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 ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious and lifethreatening hyperglycemic emergencies in patients with diabetes. 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 hyperosmolar syndrome symptoms and causes mayo. To emphasize that when there is a relative lack of insulin, a severe degree of hyperglycemia develops if there is a marked reduction in glomerular filtration rate gfr andor a large intake of glucose. Hyperglycemic hyperosmolar syndrome hhs, charac terized by extreme.
Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Doctors, as well as scientists, have worked hard to find the reasons and symptoms to identify the diseases accurately. 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 hyperglycemic state is a metabolic complication of diabetes mellitus dm characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. 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. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome the two most common lifethreatening complications of diabetes mellitus include diabetic ketoacidosis dka and hyperglycemic hyperosmolar syndrome hhs. 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. 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 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. Dec 10, 2018 hyperosmolar hyperglycemic nonketotic syndrome hhns mostly affects elderly people. What causes hyperglycemic hyperosmolar nonketotic syndrome. Diabetic ketoacidosis and hyperosmolar hyperglycemic state. 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. 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 potassium.
This article requires you to have a account to view the full text. 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. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. The condition most commonly occurs in people with type 2 diabetes. Hhs is different from diabetic ketoacidosis dka and treatment requires a different approach. Hyperosmolar hyperglycemic state diabetes care american. Osmotic demyelination syndrome due to hyperosmolar. Although dka and hhs are often discussed as separate entities, they represent points along a spectrum of hyperglycemic emergencies due to poorly controlled diabetes. The goals of treatment are to provide frequent patient monitoring, to treat the underlying cause and to gradually and safely. The hyperosmolar hyperglycemic nonketotic syndrome is also one such disease which is actually an advanced stage of type 2 diabetes. It is less common than the other acute complication of diabetes, diabetic ketoacidosis dka. Jul 01, 2018 osmotic demyelination syndrome due to hyperosmolar hyperglycemia.
Unlike dka, which can be diagnosed when blood glucose also called blood sugar values are in the range of 250300 mgdl over a few hours, hhs is diagnosed when blood. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. They each represent an extreme in the hyperglycemic spectrum. Medically speaking, it is a serious condition where the. It develops slower than dka, typically in the course of several days, but has a. Hhns stands for hyperglycemic hyperosmolar nonketotic syndrome. However, although treatment of diabetic ketoacidosis dka in children is familiar.
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. It involves extremely high blood sugar glucose level without the presence of ketones. Diagnostic tests for hyperglycemic hyperosmolar nonketotic. The list of diagnostic tests mentioned in various sources as used in the diagnosis of hyperglycemic hyperosmolar nonketotic syndrome includes. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing it into your urine. Like diabetic ketoacidosis dka, hyperglycemic hyperosmolar syndrome hhs is a deadly and avoidable complication that is due to not having enough insulin for the present condition.
Understanding the presentation of hyperglycemic hyperosmolar nonketotic syndrome. Hhs usually develops over a course of days to weeks, unlike diabetic ketoacidosis dka, which can develop in hours to a few days. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes. You do not have access to the full text of this article, the first page of the pdf of this article appears above. Pdf hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently.
Diabetic ketoacidosis and hyperosmolar hyperglycemic state in. Causes of hyperglycemic hyperosmolar nonketotic syndrome. Diabetic ketoacidosis is defined by a triad of hyper glycemia or a diagnosis of diabetes, metabolic acidosis, and ketonemia table 1. Feb 17, 2019 what causes hyperglycemic hyperosmolar nonketotic syndrome. Rapid emptying of stomach contents containing an abundant quantity of sugar. Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a consequence of the underlying precipitating causes. Hyperosmolar hyperglycemic state, diabetic hhs vs dka. Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. Hyperosmolar hyperglycemic state what you need to know.
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