The hyperglycaemic hyperosmolar state hhs is a medical emergency. It involves extremely high blood sugar glucose level without the presence of ketones. Diabetic hyperosmolar syndrome symptoms and causes mayo. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Research and education associate, wadsworth general hospital and cedars. 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. 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. Assistant professor of medicine, ucla medical center. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Dka is characterized by ketoacidosis and hyperglycemia, while hhs usually has more severe hyperglycemia but no ketoacidosis table 1. Diabetic hyperglycemic hyperosmolar syndrome hhs is a complication of type 2 diabetes.
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%. Arieff and carrolls diagnostic criteria included a blood glucose level. 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. The management of the hyperosmolar hyperglycaemic state.
Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. The condition most commonly occurs in people with type 2 diabetes. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are the two most serious metabolic complications of diabetes mellitus dm. 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. View and download powerpoint presentations on hyperglycemia hyperosmolar non ketotic coma ppt. Jan 19, 2019 hyperosmolar hyperglycemic nonketotic syndrome, or hhns, is a serious condition most frequently seen in older persons. These labels include hyperosmolar nonketotic coma, hyperosmolar hyperglycemic nonketotic coma, and hyperglycemic hyperosmolar nonketotic syndrome hackel, 2014. Evaluation at presentation revealed profound dehydration, lactic acidosis, and azotemia. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm.
Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. 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. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Neurologic and respiratory signs occurred frequently. Hyperosmolar hyperglycemic state linkedin slideshare. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes. Hyperglycemic, hyperosmolar syndrome in feline diabetics.
Hyperglycemic, hyperosmolar syndrome was seen in older cats that were often long. Hyperosmolar hyperglycemic state inpatient care what. Hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Oct 27, 2012 hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva ada american diabetes association. 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. 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. Pdf hyperosmolar hyperglycemic nonketotic syndrome in a.
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. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. Complications may include seizures, disseminated intravascular coagulopathy, mesenteric artery occlusion, or rhabdomyolysis. 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. In biochemistry, pertaining to an osmolar concentration of the body fluids that is abnormally increased. Hyperosmolar hyperglycemic nonketotic syndrome as firstlisted diagnosis total events crude rate per 1,000 95% confidence interval lower limit. As, for examples, in hyperglycemic hyperosmolar syndrome and hyperosmolar coma.
In 2010, among adults aged 20 years or older, hyperglycemic crisis caused 2,361 deaths in the u. Diabetic hyperglycemic hyperosmolar syndrome multimedia. 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. Management of the hyperosmolar hyperglycemic syndrome.
Hyperglycemic hyperosmolar state hhs is an acute complication associated with diabetes mellitus. 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. The incidence of diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome were 33. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. This draws the water out of the bodys other organs, including the brain. Diabetic ketoacidosis and hyperglycemic hyperosmolar. Hhns is an emergency caused by very high blood sugar, often over 600 mgdl. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. Mortality of hyperglycemic crisis dka is the most common cause of death in children and adolescents with type 1 diabetes. Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine. Hyperosmolar hyperglycemic state what you need to know.
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. Hhns can happen to people with either type 1 or type 2 diabetes, but it occurs more often in people with type 2. Hhs has been known by several other names in the past. Joint british diabetes societies jbds 2012 aug pdf, summary of report can be found in diabet med 2015 jun. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing. Hhs is different from diabetic ketoacidosis dka and treatment requires a different approach. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in. Hyperosmolar nonketotic coma definition of hyperosmolar. Hhns can affect both types of diabetics, yet it usually occurs amongst people with type 2 diabetes. Hyperosmolar hyperglycemic state is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. It is a condition in which the blood has a high concentration of salt sodium, glucose, and other substances. Type 2 diab w hyprosm wo nonket hyprglyhypros coma nkhhc.
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. Traumatic brain injuries are the most frequent cause. 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. 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. Hyperosmolar hyperglycemic nonketotic syndrome and. So as we mentioned earlier, hyperosmolar hyperglycemic nonketotic state is a very serious, and potentially even lifethreatening complication of type 2 diabetes. Client concerns included polydipsia, polyuria, and lethargy. Hyperosmolar hyperglycemic nonketotic syndrome, or hhns, is a serious condition most frequently seen in older persons. Dec 10, 2018 hyperosmolar hyperglycemic nonketotic syndrome hhns mostly affects elderly people. Hyperosmolar hyperglycemic nonketotic syndrome hhns. Mar 22, 2006 diabetic ketoacidosis and hyperosmolar hyperglycemic state. 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.
We performed a historical cohort study of 39,628 renal transplantation. 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. 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. Hhns is typically observed in elderly patients with noninsulindependent diabetes. 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. This syndrome is characterised by severe hyperglycaemia, a marked increase in serum osmolality, and clinical evidence of dehydration without significant accumulation of ketoacids.
Hyperosmolarity without nonketotic hyperglycemic hyperosmolar coma due to type 2 diabetes mellitus icd10cm diagnosis code e11. Acute complications of diabetes hyperosmolar hyperglycemic. Find powerpoint presentations and slides using the power of, find free presentations research about hyperglycemia hyperosmolar non ketotic coma ppt. Your body gets rid of the extra sugar through your urine. The mortality rate from hhs is significantly higher than for dka. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. Hyperglycemia hyperosmolar non ketotic coma ppt xpowerpoint. The main risk factor is a history of diabetes mellitus type. If you continue browsing the site, you agree to the use of cookies on this website. They each represent an extreme in the hyperglycemic spectrum. Intravenous fluid replacement is similar to that administered in diabetic ketoacidosis dka and. What is hyperosmolar hyperglycemic nonketotic syndrome hhns. The loss of water also makes the blood more concentrated than normal.
Hhs is characterized by severe hyperglycemia, profound dehydration, and is often. Hyperosmolar hyperglycemic state on the web most recent articles. 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. Hyperosmolar hyperglycemic state hhs endocrine and.
Hyperosmolar hyperglycemic nonketotic syndrome hhns is a complication of diabetes mellitus observed with high serum glucose, absence of ketone bodies and high hyperosmolarity. Diabetic ketoacidosis and hyperosmolar hyperglycemic state. Feb 03, 2020 hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Treatment of hyperglycaemic hyperosmolar nonketotic syndrome. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Hyperosmolar hyperglycemic state inpatient care what you. The first step of treatment involves careful monitoring.
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