Management of the hyperosmolar hyperglycaemic state hhs in. Feb 03, 2020 hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Hyperosmolar hyperglycemic state diabetes care american. 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. This article is published with open access at abstract. Pdf diabetic ketoacidosis dka and the hyperosmolar. Diabetic ketoacidosis is defined by a triad of hyper glycemia or a diagnosis of diabetes, metabolic acidosis, and ketonemia. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Diabetic hyperosmolar syndrome symptoms and causes mayo. It is less common than the other acute complication of diabetes, diabetic ketoacidosis dka.
Hyperosmolar hyperglycaemic state symptoms, diagnosis. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. Hyperosmolar hyperglycaemic state hhs is a diabetic emergency that. The hyperosmolar hyperglycemic state hhs is the most serious acute hypergly cemic emergency in patients with type 2 diabetes. According to the diabetes surveillance system of the centers for disease control and prevention cdc, overall, ageadjusted dka hospitalization rates decreased slightly from 2000 to 2009. 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%.
May 17, 2018 diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. Hyperosmolar hyperglycaemic state symptoms, diagnosis and. Diabetic emergencies ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. 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. Differentiate hyperglycemia from diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious and lifethreatening hyperglycemic emergencies in patients with diabetes. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. The hyperglycemic hyperosmolar state hhs is a clinical syndrome characterized by increased blood glucose levels and serum osmolality. Diabetes increases your risk for many serious health problems. The mortality rate in patients with diabetic ketoacidosis dka is hyperosmolar hyperglycemic state hhs still remains high. Neurologic abnormalities frequently present coma in 2550% of cases. Pdf hyperglycemic crises in adult patients with diabetes.
Aug 08, 2019 the prognosis of hyperosmolar hyperglycemic state is dependent on the degree of dehydration, the presence of comorbidities, the patients age, and the cause of the hyperosmolar hyperglycemic state. Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the two most serious acute metabolic complications of diabetes. Hyperosmolar nonketotic diabetic coma as a cause of emergency hyperglycaemic admission to baragwanath hospital. The exact incidence of hhs is not known, but it is estimated to account for hyperosmolar state hhs is a medical emergency. Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the two most serious. On the basis of the consensus statement published by the american diabetes association, diagnostic features of hyperosmolar hyperglycemic state hhs may include the following. Hyperglycemic crisis combination linked with hospital. Hyperosmolar hyperglycaemic state linkedin slideshare. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic nal crisis, trauma and, possibly, continuous subcutaneous insulin infusion csii. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. 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. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Ketoacidosis and hyperosmolar hyperglycemia are the two most serious acute metabolic complications of diabetes, even if managed properly.
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 ketoacidosis dka and hyperglycemic hyperosmolar state hhs are hyperglycemic emergencies that continue to account for increased burden of hospitalizationsinboththeusa1anduk2. These disorders can occur in both type 1 and type 2 diabetes. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. This conditionand the enormous dehydration that accompanies itoccurs most often in older persons with type 2 diabetes.
List the evaluation for a patient with hyperglycemia. Adapted with permission from kitabchi ae, umpierrez ge, murphy mb, et al american diabetes association. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. Modifications from diabetes care vol 32, issue 7, 2009. 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. The management of the hyperosmolar hyperglycaemic state hhs in adults with diabetes. The criteria for hyperglycemic hyperosmolar state hhs include. What is hyperglycemic hyperosmolar nonketotic syndrome. Patients admitted to icu via ed with hhs hyperosmolar hyperglycemic. Hyperglycemic crises in adult patients with diabetes abbas e. Hhs is different from diabetic ketoacidosis dka and treatment requires a different approach. Novel advances in the management of hyperglycemic crises uk versus usa ketan k.
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. Overview of the diabetic ketoacidosis dka hyperglycemic. Hi can anyone help me on how to code this type 2 diabetes mellitus with hyperosmolar nonketotic hyperglycemia am confused whether to use e11. Dka is responsible for more than 500,000 hospital days per year 1, 2 at an estimated annual direct.
Diabetic ketoacidosis and hyperosmolar hyperglycemic. Severely uncontrolled type 2 diabetes, usually over a relatively short period of time, can lead to a dangerous rise in blood glucose known as hyperosmolar hyperglycemic state, or hhs. Avoiding hyperglycemic hyperosmolar nonketotic syndrome. Hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Effective serum osmolality of 320 mosmkg or greater. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic nal crisis, trauma and, possibly, continuous subcutaneous insulin. Hyperosmolar hyperglycaemic state hhs occurs in people with type 2 diabetes who experience very high blood glucose levels often over 40mmoll. Hyperosmolar hyperglycaemic state aetiology bmj best. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. 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. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. Although dka and hhs are often discussed as separate entities, they represent points along a spectrum of hyperglycemic emergencies due to poorly controlled diabetes.
Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are diabetes emergencies with overlapping features. Participation is free and the site has a strict confidentiality policy. Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. Hyperosmolar hyperglycemic state what you need to know. Diabetic ketoacidosis and hyperglycemic hyperosmolar state table 1. Hyperosmolar hyperglycemic state hhs endocrine and. 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.
The management of the hyperosmolar hyperglycaemic state hhs. Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Hyperosmolar hyperglycaemic state hhs is characterised by extreme elevations in serum glucose concentrations and hyperosmolality without significant ketosis. Hyperglycemic crises in adult patients with diabetes diabetes care. What are the ada recommendations for fluid resuscitation. Your body gets rid of the extra sugar through your urine. Hyperosmolar hyperglycemic state was previously known as diabetic coma.
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. Electrolytes losses sodium 7 to meq per kg chloride 3 to 7 meq per kg potassium 5 to 15 meq per kg phosphate 70 to 140 mmol per kg calcium 50 to 100 meq per kg magnesium 50 to 100 meq per kg water 100 to 200 ml per kg. The epidemiology and the factors responsible for the metabolic abnormalities of dka and. The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis. Treatment of diabetic ketoacidosis dkahyperglycemic. However, hhs is different and treatment requires a different approach. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. Hyperosmolar hyperglycemic state hhshonc diabetic ketoacidosis adult diabetic ketoacidosis peds cerebral edema in dka. Changing the name to hyperosmolar hyperglycaemic state hhs allows for the fact that some people with severely raised blood glucose may also be mildly ketotic and acidotic. American diabetes association ada for the care of adult patients with hyperglycemic crisis and by the international society for pediatric and adolescent diabetes ispad for the care of children and adolescents with dka are excellent primary resources for diagnosis and management 1,2. 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. Hyperglycemic emergencies in adults diabetes guidelines. Hyperglycemic crises in adult patients with diabetes.
The management of the hyperosmolar hyperglycaemic state in. Hyperosmolar hyperglycemic state hhs the johns hopkins. Treatment of diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs. The condition most commonly occurs in people with type 2 diabetes. Electrolyte losses in hyperosmolar hyperglycemic state. Hyperglycemic hyperosmolar nonketotic syndrome is an extremely serious complication that can lead to diabetic coma and even death in type 2 diabetes. It can develop over a course of weeks through a combination of illness e. Fisher, md 1 d iabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhsarethetwomostseriousacute. What are the ada diagnostic criteria for hyperosmolar.
Pdf the hyperosmolar hyperglycemic state hhs is the most serious. However, with hyperosmolar hyperglycemic state, the blood glucose levels can become extremely high even exceeding 1,000 milligrams per deciliter mgdl, or 55. Based on the 2009 american diabetes association publication. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. American diabetes association from diabetes care vol 29, issue 12, 2006. For the diagnosis of ketoacidosis, the ada guidelines recommend that hyperglycemic crises in adult patients with diabetes. The management of hyperosmolar hyperglycaemic state hhs in adults with diabetes. Reprinted with permission of the american diabetes association.
A study of more than a thousand patients suggests that having both diabetic ketoacidosis dka and a hyperosmolar hyperglycemic state hhs on arrival at hospital leads to more than twice the likelihood of death there than either condition alone among 1211 patients with a first admission for confirmed hyperglycemic crisis at two us academic hospitals during a 10year. Hyperosmolar hyperglycemic state discharge care what you. Historically,bothdka and hhs were initially described as one entity but subsequently recognized as separate conditions. Dka is more common in young hyperosmolar hyperglycemic state hhs most commonly develops in individuals older than 65 years. Diabetic ketoacidosis and hyperosmolar hyperglycemic state. Dec 15, 20 hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus predominantly type 2 in which high blood sugars cause severe dehydration, increases in osmolarity relative concentration of solute and a high risk of complications, coma and death. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Wiki type 2 diabetes mellitus with hyperosmolar nonketotic. They each represent an extreme in the hyperglycemic spectrum. With the correct treatment and recommended lifestyle changes, many people with diabetes are able to prevent or delay the onset of complications. 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 33. 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.
Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Overview of the diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs episode of care 1. Complications may include seizures, disseminated intravascular coagulopathy. These metabolic derangements result from relative insulin deficiency and increased concentration of counterregulatory hormones catecholamines, glucagon, cortisol, and growth hormone.
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