Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. 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, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. Arieff and carrolls diagnostic criteria included a blood glucose level.
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. Physiopathology and management of hyperosmolar hyperglycemic nonketotic dehydration. Hyperosmolar nonketotic diabetic coma springerlink. Insulin deficiency is the main underlying abnormality. An atypical presentation of hyperosmolar nonketotic coma article pdf available in journal of medical sciences 242. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Hyperglycemic hyperosmolar syndrome symptoms, causes. Hyperglycaemic hyperosmolar nonketotic coma is a short term complication requiring immediate treatment by a healthcare professional. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels.
Pdf merge combinejoin pdf files online for free soda pdf. 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 hhspreviously referred to as hyperglycemic hyperosmolar nonketotic coma hhnk and nonketotic hyperosmolar syndrome is a complication of type 2 diabetes mellitus and has an estimated mortality rate of up to20%, which is significantly higher than the mortality for diabetic ketoacidosis currently 1%. Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction. Hyperosmolar nonketotic diabetic mellitus honkdm is a less common. Hyperosmolarity initiates a cascade of inflammatory events mediated by at least two separate pathways, leading to the recruitment and activation of inflammatory cells on the ocular surface and the production of inflammatory cytokines and chemokines see below. Associated with elevated levels of counterregulatory hormones, insulin deficiency can trigger hepatic glucose production and reduced glucose uptake, resulting in. Oct 23, 20 hyperglycemic hyperosmolar syndrome hhs is a type2 diabetes complication involving extremely high blood sugar levels without ketones. Physiopathology and management of hyperosmolar hyperglycemic. Hhns is an emergency caused by very high blood sugar, often over 600 mgdl. Seven of these were complicated by other illnesses. Common precipitating factors in hnc included infection, dehydration and administration of diabetogenic drugs. Clinical and metabolic characteristics of hyperosmolar. Risk calculators and risk factors for hyperosmolar hyperglycemic state.
The exact incidence of hhs is not known, but it is estimated to account for hyperosmolar nonketotic syndrome vs. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in. Management of the hyperosmolar hyperglycemic syndrome. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Nonketotic hyperosmolar coma in the postoperative patient hyperosmolar nonketotic coma in the elderly diabetic deaths associated with diabetic ketoacidosis and hyperosmolar coma a case of mediastinitis accompanied with hyperosmolar nonketotic coma. Dec 10, 2018 hyperosmolar hyperglycemic nonketotic syndrome hhns mostly affects elderly people. Start studying hyperglycemia hyperosmolar nonketotic syndrome vs. It involves extremely high blood sugar glucose level without the presence of ketones. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. Hyperosmolar hyperglycemic state what you need to know. What is hyperosmolar hyperglycemic nonketotic syndrome hhns. Oct 10, 2014 the hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis.
Mar 06, 2012 definitions dka consists of the biochemical triad of hyperglycemia, ketonemia and metabolic high anion gap acidosis the term hyperglycemic hyperosmolar nonketotic coma has been replaced with the term hyperglycemic hyperosmolar state hhs 1the hyperglycemic hyperosmolar state may consist of moderate to variable degrees of. Dka is characterized by ketoacidosis and hyperglycemia, while hhs usually has more severe hyperglycemia but no ketoacidosis table 1. 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. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing. Predisposing factors for the diabetic hyperosmolar state.
Hyperosmolar hyperglycemic state linkedin slideshare. An appropriate duration of time 216 weeks depending on agents used between increments should be given to allow achievement of steady state blood glucose control shortterm use. In biochemistry, pertaining to an osmolar concentration of the body fluids that is abnormally increased. Hyperglycemic hyperosmolar syndrome at the onset of type 2. See causes and risk factors by clicking the pdf icon above. Diabetic hyperglycemic hyperosmolar syndrome hhs is a complication of type 2 diabetes.
Typically, the patient, a middleaged or old person with diabetes mellitus of recent onset or without previous history of the disease, lapses into stupor and unconsciousness after manifesting prodromal neurological symptoms, such as. If you continue browsing the site, you agree to the use of cookies on this website. Hyperglycemic, hyperosmolar syndrome in feline diabetics. Prediction of seizure control in nonketotic hyperglycemic. Hyperglycemic hyperosmolar nonketotic syndrome hhns is one of the most severe acute complications of diabetes. These hormonal increases and poor insulin response combine to cause hyperglycemia. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes.
Hyperglycemic hyperosmolar state hhs is rare in the paediatric population. Hyperosmolar hyperglisemic nonketotic coma honkc is a rare complication of type 2 diabetes mellitus dm. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes. The authors report the case of a 12yearold boy with hyperosmolar nonketotic diabetic coma. Seven died, but in five death was probably not due to the hyperosmolar state. Client concerns included polydipsia, polyuria, and lethargy. Acute illness, surgery, stress and emergencies pregnancy breastfeeding insulin may be used as initial therapy in type 2 diabetes in marked hyperglycaemia severe.
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. May 03, 2018 diabetic hyperosmolar syndrome is a medical emergency that you wont have time to prepare for. Definition also referred to as hyperosmolar hyperglycemic state hhs, nonketotic hyperosmolar coma nkhoc is an acute complication of diabetes meillitus type 2. Traumatic brain injuries are the most frequent cause. Pdf zusammenfugen pdfdateien online kostenlos zu kombinieren. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Pdf diagnosis and treatment of diabetic ketoacidosis and. Symptoms of honk before loss of consciousness and coma takes place, patients will display signs of. Glycerol and hyperosmolar nonketotic coma pdf free download. High dose of furosemide associated with severe acidbase. Hyperosmolar hyperglycemic nonketotic syndrome hhns. A variety of crystalloid fluids is currently available for use and differs in their composition and ion concentrations.
Hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are the most. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. Also referred to as hyperosmolar hyperglycemic state hhs, nonketotic hyperosmolar coma nkhoc is an acute complication of diabetes meillitus type 2. Kitabchi, phd, md, and mary beth murphy, rn, mst diabetic ketoacidosis dka and hyperosmolar hyperglycemic nonketotic coma hhnc are two of the most common acute complications of diabetes that have devastating outcomes if not treated promptly. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Elisaf, md, frsh c nonketotic hyperglycemic hyperosmolar syndrome hhs is found mostly in type 2 diabetic patients with marked hyperglycemia. Landsberg md, in clinical practice manual for pulmonary and.
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. While there are potential pros and cons for different. See also hyperglycemic hyperosmolar nonketotic coma. Hyperosmolar hyperglycemic state is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Twelve cases of diabetic hyperosmolar coma without ketosis are described in ten patients. Hyperosmolar nonketotic coma definition of hyperosmolar. Pdf an atypical presentation of hyperosmolar nonketotic. Feb 26, 2019 nonketotic hyperosmolar coma is a life threatening metabolic derangement that can develop in people with diabetes mellitus, usually due to illness, infection or failure to monitor blood glucose. In one study18 of an urban population presenting with hyperos molar hyperglycemic state, the three leading causes were poor compliance with medica tion, ethanol ingestion, and cocaine use.
Hyperosmolar hyperglycaemic state bmj best practice. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome hhns. Diabetic ketoacidosis and the hyperglycemic hyperosmolar state are the most serious complications of diabetic decompensation and remain associated with excess mortality. Komplikasi dm free download as powerpoint presentation. The management of hyperosmolar hyperglycaemic state hhs in adults with diabetes. Nonketotic hyperglycemiarelated seizures nkh are rare. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome the two most common lifethreatening complications of diabetes mellitus include diabetic ketoacidosis dka and hyperglycemic hyperosmolar syndrome hhs. Diabetic ketoacidosis and hyperglycemic hyperosmolar. Hyperosmolar hyperglycaemic state symptoms, diagnosis. Get a printable copy pdf file of the complete article 798k. Diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic. Occurs most commonly in older people with type 2 diabetes.
How to recognize and intervene for hyperosmolar hyperglycemic. Oct 17, 2016 hyperglycemic hyperosmolar syndrome by. Hyperosmolar hyperglycemic state dr sudeepta rao, pg 2nd yr gen med dcms slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Complications may include seizures, disseminated intravascular coagulopathy. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus.
Hyperosmolar syndrome in a patient with uncontrolled diabetes. Hyperosmolar diabetic coma ketotic and nonketotic jama. It was also named hyperglycemic hyperosmolar nonketotic state, but findings of. Hyperglycemic hyperosmolar nonketotic syndrome with. Neurologic and respiratory signs occurred frequently. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. Evaluation at presentation revealed profound dehydration, lactic acidosis, and azotemia. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state. Treatment of hyperglycaemic hyperosmolar nonketotic syndrome. The sudden increased level of sugar result in hypotension and tachycardia, complicating into coma and death. Pathogenetic aspects and the hla genotype are discussed. Oct 27, 2012 hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. In both syndromes, there is insufficient insulin levels to transport. Multiple linear regression analysis was used to identify the factors predictive for seizure control.
Your body gets rid of the extra sugar through your urine. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed. Hyperosmolar syndrome in a patient with uncontrolled diabetes mellitus haralampos j. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently.
Hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped. Contributes to less than 1% of all diabetesrelated admissions. The condition most commonly occurs in people with type 2 diabetes. The hallmark of hhns is profound dehydration, marked hyperglycemia, and often some degree of neurologic impairment with mild or no ketosis 1. Soda pdf merge tool allows you to combine two or more documents into a single pdf file for free.
Nonketotic diabetic coma has emerged as a distinct syndrome mediated by the hyperosmolarity of the blood. To better understand risk factors for the development of diabetic hyperosmolar state dhs, we studied 5 patients with dhs and 5 agematched randomly selected diabetic controls admitted to two general hospitals during an 11year period. 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%. Diabetic hyperosmolar syndrome symptoms and causes mayo. They each represent an extreme in the hyperglycemic spectrum. Hyperosmolar definition of hyperosmolar by medical dictionary. Dj 1995 electrocardiography, in miller ms, tilley lp eds. Diabetic hyperosmolar syndrome disease reference guide. Diabetic emergencies ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. 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. The goals of treatment are to provide frequent patient monitoring, to treat the underlying cause and to gradually and safely. The incidence of diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome were 33.
Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious and lifethreatening hyperglycemic emergencies in diabetes. 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. 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. Diabetic hhs is a condition of severely high blood sugar, extreme lack of water dehydration, and decreased consciousness. Hhs is a metabolic emergency and is associated with a high mortality. Hhns is typically observed in elderly patients with noninsulindependent diabetes. 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. The possible mechanisms are hyperglycemia or hyperosmolarity, a low. Presents with polyuria, polydipsia, weakness, weight loss, tachycardia, dry mucous membranes, poor skin turgor, hypotension, and, in s.
Request pdf diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome diabetic ketoacidosis dka and hyperglycemic. The too rapidly infused sodiumbicarbonate overloaded the body with sodium and caused intracellular sodium accumulation with edema. 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. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. Most patients had no previous history of diabetes and presented with repetitive. To study the factors predictive for seizure control in nonketotic hyperglycemic induced seizures nkhs. As glucose builds up in your blood, your body tries to get rid of it through your urine. Hyperosmolar hyperglycemic state hhs endocrine and. Nonketotic hyperglycemiarelated epileptic seizures ncbi. Hyperglycaemic hyperosmolar nonketotic coma is a dangerous condition brought on by very high blood glucose levels in type 2 diabetes above 33 mmoll.
Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. Clinical and metabolic data of twenty patients with hyperosmolar nonketotic coma hnc and ten patients in ketoacidosis da are compared. Rhabdomyolysis is an unusual but underestimated complication of hhns 2. Hyperosmolar hyperglycemic state an overview sciencedirect. This syndrome is characterised by severe hyperglycaemia, a marked increase in serum osmolality, and clinical evidence of dehydration without significant accumulation of ketoacids. The management of the hyperosmolar hyperglycaemic state hhs. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. 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. Longterm steroid use19 and gastroenteritis20 are common causes of hyperosmolar hyper glycemic state in. Patients admitted to icu via ed with hhs hyperosmolar hyperglycemic state. Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are lifethreatening complications of diabetes mellitus which require prompt treatment with large volume crystalloid fluid administration.
1190 1177 1451 630 1663 105 432 936 870 665 740 602 1010 1436 638 422 40 1110 1360 816 1310 699 1319 1076 1074 1165 747 895 652 691 1137 1359 1640 596 183 28 880 1541 89 565 1489 543 351 1467 1143 907 1273 378 726 626 1192