Hyperosmolar hyperglycemic state hhs, also known as nonketotic hyperglycemic hyperosmolar syndrome nkhs, is characterized by profound hyperglycemia glucose 600 mgdl, hyperosmolality effective serum osmolality. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. In new onset diabetes, dka is frequently the consequence of a delay in diagnosis e. Unlike the other common diabetes emergency, diabetic ketoacidosis dka, guidelines on the management of the hyperglycaemic hyperosmolar state hhs in adults are uncommon and often there is little to differentiate them from the management of dka. Diabetic hyperosmolar syndrome symptoms and causes mayo. Devi r, selvakumar g, clark l, downer c, braithwaite ss. Diabetic ketoacidosis dka is characteristically associated with type 1 diabetes. Largescale studies to determine optimal management of dka and hhs are lacking.
Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious and lifethreatening hyperglycemic emergencies in patients with diabetes. Dka without a preceding febrile illness or gastroenteritis in a patient with known diabetes is almost always the result of psychosocial problems and failure to appropriately administer insulin. Diagnosis and treatment of diabetic ketoacidosis and the. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state. 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. Hhs occurs mostly in adults and elderly patients and has a.
Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. Diabetic ketoacidosis and hyperosmolar hyperglycemic state are medical emergencies that require treatment and monitoring for. Diabetic ketoacidosis and hyperosmolar hyperglycemic state are medical emergencies that require treatment and monitoring for multiple metabolic abnormalities and vigilance for complications. Diabetic ketoacidosis and the hyperglycemic hyperosmolar state key points dka and hhs are lifethreatening emergencies. Youll likely have blood and urine tests to measure your blood sugar level and kidney function and to detect infection, among other conditions. Management of diabetic ketoacidosis and hyperglycemic. 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 hyperglycaemic hyperosmolar state hhs is a medical emergency. The management of the hyperosmolar hyperglycaemic state hhs. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. See diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults.
Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. The epidemiology, pathogenesis, clinical features, evaluation, and diagnosis of these disorders are discussed separately. Hyperglycemic hyperosmolar state diabetic hyperglycemic hyperosmolar state hhs occurs in patients with type 2 diabetes and has a markedly higher mortality rate than dka. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction. Diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs are potentially fatal hyperglycemic crises that occur as acute complications of uncontrolled diabetes mellitus. 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. 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. The criteria for hyperglycemic hyperosmolar state hhs include. Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the two most serious. Hyperglycemic emergencies in adults canadian journal of diabetes. Because the approach to the diagnosis and treatment of these hyperglycemic crises are similar, we have opted to address them.
Chiasson jl1, arisjilwan n, belanger r, bertrand s, beauregard h, ekoe jm, fournier h, havrankova j. Hospital management of diabetes awallia and jj seley, section editors treatment of diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs. Emergency department management of diabetic ketoacidosis and. Describe the epidemiology of diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs differentiate between dka and hhs list factors that may precipitate dka and hhs identify the metabolic derangements observed in dka and hhs describe the treatment of dka and hhs as it relates to their pathophysiology.
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. 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. 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%. Hhs is different from diabetic ketoacidosis dka and treatment requires a different approach. 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 pdf, summary of report can be found in diabet med 2015 jun. They are potentially lifethreatening and require swift recognition and treatment. Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a consequence of the underlying precipitating causes rather.
Umpierrez ge, cuervo r, karabell a, latif k, freire ax, kitabchi ae. Pdf treatment of diabetic ketoacidosis dkahyperglycemic. A persons breath may develop a specific fruity smell. 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 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. The emergency medical team will do a physical and mental status exam and may ask those who are with you about your medical history. Hyperglycemic emergencies diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are common presentations in the ed that require swift, specialized management strategies. Apr 01, 2003 diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs appear as 2 extremes in the spectrum of diabetic decompensation. Novel advances in the management of hyperglycemic crises uk versus usa ketan k. Hyperosmolar nonketotic diabetic coma as a cause of emergency hyperglycaemic admission to baragwanath hospital. Treatment of dka and hhs also differs with respect to timing of fluid and insulin initiation. The epidemiology, pathogenesis, clinical features, evaluation, and diagnosis of.
Diabetic emergencies ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Hyperosmolar hyperglycemic state symptoms, diagnosis and. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. It must be emphasized that successful treatment of dka and hhs. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing. Clinical features, evaluation, and diagnosis and diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults. Gastroenteritis hyperosmolar alcoholic ketoacidosis hyperglycemic state myocardial infarction.
Diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs appear as 2 extremes in the spectrum of diabetic decompensation. Hyperglycemic crises in adult patients with diabetes diabetes care. For diabetic hyperosmolar syndrome, prompt diagnosis is critical. Because the approach to the diagnosis and treatment of these hyperglycemic. Management of diabetic ketoacidosis and hyperglycemic hyperosmolar state in adults. Hyperosmolar hyperglycemic state hhs endocrine and. Diabetic ketoacidosis dka and hyperosmolar hyperglycaemic state hhs remain two of the most commonly encountered metabolic emergencies. 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. Diabetic ketoacidosis is defined by a triad of hyper glycemia or a diagnosis of diabetes, metabolic acidosis, and ketonemia table 1. Full text management of adult diabetic ketoacidosis dmso. Management of hyperosmolar hyperglycaemic state in adults. The management of the hyperosmolar hyperglycaemic state in. The management of the hyperosmolar hyperglycaemic state.
Hyperosmolar hyperglycemic state american family physician. However, hhs is different and treatment requires a different approach. May 17, 2015 the key points in these hhs guidelines include. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are diabetic emergencies that cause high morbidity and mortality. 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.
Treatment of diabetic ketoacidosis with subcutaneous insulin aspart. They are both potentially lifethreatening when not managed correctly. Dka occurs most frequently but not exclusively in people with type 1 diabetes mellitus, who are absolutely insulindeficient. 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 clinical features, evaluation, diagnosis, and treatment of these disorders are discussed separately. Diabetic ketoacidosis dka is a potentially lifethreatening complication of diabetes mellitus. The condition most commonly occurs in people with type 2 diabetes. Table 4 describes physician attitudes toward patients who present to the ed repeatedly for treatment of hyperglycemic emergencies.
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. Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the two most serious acute metabolic complications of diabetes. Treatment of diabetic ketoacidosis dkahyperglycemic. Dec 01, 2017 hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. Management of the hyperosmolar hyperglycaemic state hhs in. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum.
Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Target audience this educational activity has been designed to meet the educational needs of pharmacists and registered nurses involved in the management of patients with diabetes. Diabetic ketoacidosis and hyperosmolar crisis in adults. May 29, 2019 diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Dka is responsible for more than 500,000 hospital days per year 1,2 at an estimated annual direct medical expense and indirect cost of 2. When a responsible adult administers insulin there. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped. Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Uncovering the precipitating event is critical to management, as morbidity and mortality are related more to the trigger than the dkahhs itself. Diabetic ketoacidosis and hyperglycemic hyperosmolar. Hyperglycemic crises in adult patients with diabetes.
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. Diabetic hyperosmolar syndrome diagnosis and treatment. Treatment of diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs. Management of diabetic ketoacidosis and hyperosmolar. A dosedefining insulin algorithm for attainment and maintenance of glycemic targets during therapy of hyperglycemic crises. The management of hyperosmolar hyperglycaemic state hhs in adults with diabetes. It is less common than the other acute complication of diabetes, diabetic ketoacidosis dka. 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. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults. In 2010, among adults aged 20 years or older, hyperglycemic crisis caused 2,361 deaths 9. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Diabetic ketoacidosis and hyperglycemic hyperosmolar state table 1. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Table 1 outlines the diagnostic criteria for dka and hhs.
266 598 527 1506 325 1234 629 650 663 1410 645 888 777 1020 543 1193 1125 563 1349 841 1202 5 818 282 1437 663 506 1171 875 1146 1496 582 421 1473 33 1321 548 209 1463 21