The first detailed clinical description of diabetic coma in an adult patient with severe. 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. These disorders can occur in both type 1 and type 2 diabetes. Oct 17, 2016 hyperglycemic hyperosmolar syndrome by. Hyperosmolar hyperglycemic syndrome hhs can have lifethreatening symptoms. Patients with this syndrome present with hyperglycemia. Diabetic ketoacidosis and hyperglycemic hyperosmolar. Hyperglycemic hyperosmolar nonketotic syndrome hhns caused by lack of insulin or insulin resistance with resulting hyperglycemia which causes osmotic diuresis. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. Hyperosmolar hyperglycemic state hhs endocrine and. Diabetic hyperosmolar syndrome is a medical emergency that you wont have time to prepare for. Hhs is different from diabetic ketoacidosis dka and treatment requires a different approach. How is glucose affected by hyperosmolar hyperglycemic state.
Hyperosmolar syndrome in a patient with uncontrolled. How to recognize and intervene for hyperosmolar hyperglycemic. Risk factors for hyperglycemic hyperosmolar syndrome were similar. An acute decompensated state in which patients manifest a change in mental status in the setting of hyperglycemia, hyperosmolarity and. Less common than other diabetesrelated hyperglycemic syndromes. Hyperosmolar hyperglycemic nonketotic syndrome hhns. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar nonketotic syndrome hhns are lifethreatening acute metabolic complications of diabetes mellitus. The mortality rate in patients with diabetic ketoacidosis dka. With hhs, an individual is hyperosmolar which means the chemical content of the blood is now dissolved in less than the normal amount of water due to reduced fluid intake. 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. Most cases of hhs are seen in elderlypatientswithtype2diabetes. Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. Treatment is aggressive rehydration, insulin therapy, electrolyte replacement, and treatment of underlying precipitating events. Hyperglycemic hyperosmolar state hhs is rare in the paediatric population.
Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome hhns. The exact incidence of hhs is not known, but it is estimated to account for,1% of hospital admissions in patients with diabetes 1. See causes and risk factors by clicking the pdf icon above. Extreme dehydration eventually leads to confusion and lack of ability to even get a drink or make it to the toilet. The management of the hyperosmolar hyperglycaemic state. What are the symptoms of hyperosmolar hyperglycemic. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Hyperosmolar hyperglycemic state an overview sciencedirect. Hyperosmolar hyperglycemic nonketotic state is a lifethreatening emergency manifested by a marked elevation of blood glucose, hyperosmolarity, and little or no ketosis. Water shift from intracellular to intravascular compartment resulting in hypernatremia and increased osmolarity. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the. Treatment of hyperglycaemic hyperosmolar nonketotic syndrome.
Hyperglycaemic crisis in the eastern cape province of south africa. Although there are some important differences, the pathophysiology, the presenting clinical challenge, and the treatment of these metabolic derangements are similar. 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 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. Too much glucose in your blood also called hyperglycemia or high blood sugar can cause many problems.
Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. 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. High mortality and association of hyperosmolar ketoacidosis with a new diagnosis of diabetes. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. The exact incidence of hhs is not known, but it is estimated to account for 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 state asped. It most often occurs in type 2 dm, often in the setting of physiologic stress.
The condition most commonly occurs in people with type 2 diabetes. Hyperglycemic hyperosmolar syndrome hhs is a critical complication of diabetes mellitus that requires immediate diagnosis and treatment. An acute decompensated state in which patients manifest a change in mental status in the setting of hyperglycemia, hyperosmolarity and severe volume depletion. 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. However, with hyperosmolar hyperglycemic state, the blood glucose levels can become extremely high even exceeding 1,000 milligrams per deciliter mgdl, or 55. Diabetic ketoacidosis dka is something we that is always on our mind as an em provider, but have you thought of hyperglycemic hyperosmolar syndrome hhs. Oct 10, 2014 the hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis. It involves extremely high blood sugar glucose level without the presence of ketones.
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. Therefore, this merged platform can be considered a multi. 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%. The management of the hyperosmolar hyperglycaemic state in. Txunos was used as the primary dataset, and merged with variables from saf.
Hyperosmolar syndrome in a patient with uncontrolled diabetes. Hhs is a metabolic emergency and is associated with a high mortality. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. Hyperosmolar hyperglycemic state what you need to know. Hyperosmolar hyperglycemic syndrome with rhabdomyolysis. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in. Hyperglycemic hyperosmolar syndrome at the onset of type 2.
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. The hyperglycaemic hyperosmolar state hhs is a medical emergency. It is less common than the other acute complication of diabetes, diabetic ketoacidosis dka. Diabetic hyperglycemic hyperosmolar syndrome hhs is a complication of type 2 diabetes. Left untreated, diabetic hyperosmolar syndrome can lead to lifethreatening dehydration.
Start studying hyperglycemia hyperosmolar nonketotic syndrome vs. Hhns can affect both types of diabetics, yet it usually occurs amongst people with type 2 diabetes. Feb 03, 2020 hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing it into your urine. When you have hhs, you are also hyperglycemic meaning the levels of glucose in the blood are too high. Oct 27, 2012 hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus.
As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing. Hyperglycemia hyperglycemic hyperosmolar nonketotic coma. Hyperglycemiainduced volume depletion without acidosis hyperosmolar hyperglycemic state hhsis an insidiously developing lifethreatening medical 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. Usually, hhns is brought on by an illness or infection. Treatment of hyperglycaemic hyperosmolar nonketotic. Diabetic ketoacidosis and the hyperosmolar state would not have been possible if not for the excellent initial chapter authored by drs. Hyperosmolar nonketotic syndrome with hypernatremia.
Pdf hyperglycemic hyperosmolar state after transsphenoidal. 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. The management of the hyperosmolar hyperglycaemic state hhs. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. Hhns is typically observed in elderly patients with noninsulin. Many nurses combine discharge planning and patient education. Pdf overview of cerebral edema during correction of. 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. Hhns is typically observed in elderly patients with noninsulindependent diabetes. Diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome. Quality standards for diabetes care toolkit ministry of health nz.
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 syndrome occurs because as blood glucose levels go higher and higher, urine output goes up, and dehydration sets in. Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus dm characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. Diabetic hyperosmolar syndrome symptoms and causes mayo. Diabetic ketoacidosis and hyperglycaemic, hyperosmolar nonketotic 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.
It was also named hyperglycemic hyperosmolar nonketotic state, but findings of. 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. Hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. If you continue browsing the site, you agree to the use of cookies on this website. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Elisaf, md, frsh c nonketotic hyperglycemic hyperosmolar syndrome hhs is found mostly in type 2 diabetic patients with marked hyperglycemia.
Your body gets rid of the extra sugar through your urine. Hyperosmolar hyperglycemic syndrome in the elderly diabetic. 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. All hospitals should have a dedicated diabetes inpatient specialist nurse service at a. 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 syndrome in a patient with uncontrolled diabetes mellitus haralampos j. Hyperglycemic crises in diabetes american diabetes association k etoacidosis and hyperosmolar hyperglycemia are the two most serious acute metabolic complications of diabetes, even if managed properly. Diabetic hyperosmolar syndrome symptoms and causes. Hyperosmolar hyperglycemic state linkedin slideshare. Hyperglycemia, hyperosmolar nonketotic syndrome in children. These hormonal increases and poor insulin response combine to cause hyperglycemia. Diabetic hyperosmolar syndrome disease reference guide. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness.