Hyperosmolar hyperglycemic nonketotic syndrome hhns mostly affects elderly people. Twelve cases of diabetic hyperosmolar coma without ketosis are described in ten patients. 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 hyperglycaemic hyperosmolar state hhs is a medical emergency. As glucose builds up in your blood, your body tries to get rid of it through your urine. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with 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%. 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, also known as hyperosmotic hyperglycemic nonketotic state hhnk are two of the most serious acute complications of diabetes. Diabetic hyperglycemic hyperosmolar syndrome hhs is a complication of type 2 diabetes. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome management emergency medicine. Hyperglycemic hyperosmolar nonketotic syndrome hhns is an emergency that the diabetes mellitus dm patient may experience. Hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus.
With the correct treatment and recommended lifestyle changes, many people with diabetes are able to prevent or delay the onset of complications. The condition is also commonly referred to as hyperglycemic. Evaluation at presentation revealed profound dehydration, lactic acidosis, and azotemia. Hhs is different from diabetic ketoacidosis dka and treatment requires a different approach. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. The exact incidence of hhs is not known, but it is estimated to account for hyperosmolar nonketotic syndrome hhns is an emergency that the diabetes mellitus dm patient may experience.
Hyperglycemic, hyperosmolar syndrome in feline diabetics. Hyperosmolar hyperglycemic state american family physician. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. Hyperglycemic hyperosmolar nonketotic syndrome medind. 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. Hyperglycemic hyperosmolar syndrome hhs, charac terized by extreme. The hyperosmoiar hyperglycemic nonketotic syndrome, also referred to as hyperglycemic hyperosmolar nonketotic coma, is a weilrec ognized clinical entity first. Arieff and carrolls diagnostic criteria included a blood glucose level. Hhns can affect both types of diabetics, yet it usually occurs amongst people with type 2 diabetes.
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. Hhns is an emergency caused by very high blood sugar, often over 600 mgdl. If you feel the symptoms of extreme high blood sugar, call 911 or your local. Hyperosmolar hyperglycemic state discharge care what. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute. 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. Hyperglycemic, hyperosmolar syndrome was seen in older cats that were often long. Seven died, but in five death was probably not due to the hyperosmolar state. Diabetic ketoacidosis and hyperglycemic hyperosmolar. The management of the hyperosmolar hyperglycaemic state. Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction. May 29, 2019 diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Hyperosmolar hyperglycemic state discharge care what you.
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. Client concerns included polydipsia, polyuria, and lethargy. Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. Diabetes increases your risk for many serious health problems. Hyperosmolar hyperglycemic nonketotic syndrome hhns is a complication of diabetes mellitus observed with high serum glucose, absence of ketone bodies and high hyperosmolarity. Hyperosmolar hyperglycaemic state symptoms, diagnosis and. Hyperosmolar hyperglycemic state is a lifethreatening emergency. A form of diabetic coma seen in type 2 diabetes mellitus. Now it is being diagnosed with increasing frequency in. What is hyperglycemic hyperosmolar nonketotic syndrome. Hyperosmolar hyperglycemic nonketotic syndrome sciencedirect. The condition most commonly occurs in people with type 2 diabetes.
Hyperosmolar hyperglycemic nonketotic syndrome symptoms. Hyperglycemic hyperosmolar nonketotic syndrome is an extremely serious complication that can lead to diabetic coma and even death in type 2 diabetes. Hyperosmolar hyperglycaemic state symptoms, diagnosis. Hyperosmolar hyperglycemic state diabetes care american. More detailed information about the symptoms, causes, and treatments of hyperosmolar hyperglycemic nonketotic syndrome is available below symptoms of hyperosmolar hyperglycemic nonketotic syndrome. It involves extremely high blood sugar glucose level without the presence of ketones.
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. Hyperosmolar hyperglycemic nonketotic syndrome hhns. Hyperosmolar hyperglycemic state clinical presentation. 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. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. The management of hyperosmolar hyperglycaemic state hhs in adults with diabetes. Seven of these were complicated by other illnesses.
What is hyperosmolar hyperglycemic nonketotic syndrome hhns. Diabetic hyperosmolar syndrome is a medical emergency that you wont have time to prepare for. More detailed information about the symptoms, causes, and treatments of hyperosmolar hyperglycemic nonketotic syndrome is available below. Diabetic emergencies ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia.
Neurologic and respiratory signs occurred frequently. Diabetic ketoacidosis and hyperosmolar hyperglycemic. 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 endocrine and. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm.
Usually, hhns is brought on by an illness or infection. It is less common than the other acute complication of diabetes, diabetic ketoacidosis dka. 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. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Feb 17, 2019 hyperglycemic hyperosmolar nonketotic syndrome is an extremely serious complication that can lead to diabetic coma and even death in type 2 diabetes. Hyperosmolarity dehydration severe clinical not always ketotic or low levels more common in cats than dogs severe hyperglycemia 600 mgdl 33 mmoll hyperosmolarity 350 mosmkg dehydration lack of ketones.
The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia. 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. Hyperosmolar hyperglycemic state linkedin slideshare. Dec 10, 2018 hyperosmolar hyperglycemic nonketotic syndrome hhns mostly affects elderly people. Hyperglycemic hyperosmolar syndrome in children diabetes. Hyperosmolarity dehydration severe clinical not always ketotic or low levels more common in cats than dogs severe hyperglycemia 600 mgdl 33 mmoll hyperosmolarity. 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. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently.
Diabetic hyperosmolar syndrome symptoms and causes mayo. Diabetic hyperosmolar syndrome symptoms and causes. Hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Hhs occurs when a persons blood glucose sugar levels are too high for a long period, leading to severe dehydration extreme thirst and confusion. Diabetic hyperosmolar syndrome disease reference guide. Oct 10, 2014 the hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis.
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. Dec 01, 2017 hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. Stay alert for symptoms of skin infections and other skin disorders common in people. The hyperosmolarity in this syndrome is due to either gross hyperglycemia or. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. 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 hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes. Doc hyperglycemic hyperosmolar otonan otonan academia. Pdf hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome the two most common lifethreatening complications of diabetes mellitus include diabetic ketoacidosis dka and hyperglycemic hyperosmolar syndrome hhs. The authors report no actual or potential conflict of interest in relation to this article. Hyperosmolar hyperglycaemic state hhs is a diabetic emergency that.