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. Combined with the insufficiency of insulin effect, there is an increase in. Though there are many differences between dka and hhs, the basic problem is associated with insulin deficiency. Management of diabetic ketoacidosis and hyperosmolar. The diabetes specialist team should be involved as soon as possible after admission. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. Hyperosmolar hyperglycemic state american family physician. Hyperosmolar hyperglycemic state, diabetic hhs vs dka. Blogs on hyperosmolar hyperglycemic state pathophysiology.
Whilst dka presents within hours of onset, hhs comes on over many days, and. Treatment begins with intensive monitoring of the patient and laboratory values, especially glucose. Typically, patients with type 1 diabetes are more likely to exhibit. Hhs is a state with less severe insulin deficiency than dka. A lecture on the recognition, pathogenesis, and management of diabetic ketoacidosis and the hyperosmolar hyperglycemic state.
The pathophysiology of hhs is illustrated in figure 1. Oct 10, 2014 the hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis. Diabetes spectrum volume 15, number 1, 2002 in brief diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome the two most common lifethreatening complications of diabetes mellitus include diabetic ketoacidosis dka and hyperglycemic hyperosmolar syndrome hhs. Type 2 diabetes, also called noninsulin dependent diabetes mellitus niddm, is caused by decreased sensitivity of target tissues to insulin. Cdc on hyperosmolar hyperglycemic state pathophysiology. The exact incidence of hhs is not known, but it is estimated to account for hospital admissions in patients with diabetes 1. When comparing the two, hhs has a higher mortality. Patients admitted to icu via ed with hhs hyperosmolar hyperglycemic state will be monitored and managed appropriately.
Purpose provide clinicians treating patients with diabetes the. The exact incidence of hhs is not known, but it is estimated to account for diabetes. Diabetic ketoacidosis and hyperglycemic hyperosmolar state risk factors for dka in patients with known dia betes include insulin omission, poor metabolic control. Pathophysiology the basic cause of dka and hhs is insufficient insulin effect. D iabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are acute and potentially lifethreatening complications of diabetes. Dec 01, 2017 hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. Dka and hhs remain important causes of morbidity and mortality among diabetic patients despite well developed diagnostic criteria and treatment protocols 1. Although there are important differences in their patho. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. Diabetic ketoacidosis dka msd manual professional edition. Both dka and hhs are the two complications of diabetes mellitus. 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. It is important to be familiar with the pathophysiology, presentation, treatment, complications, andperhaps most importantlyprevention of dka and hhs.
Hyperosmolar hyperglycemic nonketotic syndrome vs dka. May 29, 2019 diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. Clinical presentation, diagnosis, and treatment diabetes care. Fluid losses in hhs are estimated to be between 100 220 mlkg 1022 litres in a person weighing 100 kg. The management of the hyperosmolar hyperglycaemic state hhs. The criteria for hyperglycemic hyperosmolar state hhs include. A case study by tyrell hardtke university of washington. Although they have important differences, they both occur because of lack of insulin effect and can be considered two manifestations of the same underlying mechanism. Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. 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. It most often occurs in type 2 dm, often in the setting of physiologic stress.
In children and adolescents, hyperosmolar hyperglycemic state is often present when type 2 diabetes is diagnosed. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. Physical findings include profound dehydration and neurologic symptoms ranging from lethargy to coma. In both syndromes, there is insufficient insulin levels to transport. In the usual clinical situation, a rise in counterregula. Diabetic ketoacidosis and hyperosmolar crisis in adults. The basic cause of dka and hhs is insufficient insulin effect. Pathophysiology and clinical guidelines the academy of dental learning and osha training, llc, designates this activity for 7 continuing education credits 7 ces. Diabetic ketoacidosis dka is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the bodys basic metabolic requirements.
Both diabetic ketoacidosis and hhs result from relative or. The subsequent lack of insulin leads to increased blood and urine glucose. Dka usually occurs in type 1 diabetes, but may also develop in type 2 diabetes with severe illness or in ketosisprone type 2 diabetes. Guideline title management of hyperosmolar hyperglycemic state.
The condition most commonly occurs in people with type 2 diabetes. 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. Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus dm characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing. Hyperosmolar hyperglycemic state pathophysiology in the news. Oct 31, 2017 hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose.
It develops slower than dka, typically in the course of several days, but has a. Hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. The classical symptoms are polyuria, polydipsia, polyphagia, and weight loss.
Jul 31, 2011 a lecture on the recognition, pathogenesis, and management of diabetic ketoacidosis and the hyperosmolar hyperglycemic state. The annual incidence of dka from populationbased studies is estimated to range from 4 to 8 episodes per 1,000 patient admissions with diabetes 2. Downloadmanagement of the hyperosmolar hyperglycaemic state hhs in adults with diabetes pdf, 3mb. 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. Hyperosmolar hyperglycemic state symptoms, diagnosis and. Hhs is associated with a significant morbidity and higher mortality than dka and must be diagnosed promptly and managed intensively savage 2011.
The aim of jbdsip is to improve inpatient diabetes care throughout the uk. In new onset diabetes, dka is frequently the consequence of a delay in diagnosis e. This is mainly through the development and use of high quality evidence based guidelines, and through better inpatient care pathways. Hhs usually presents in elderly patients and can be the first presentation of type 2 diabetes mellitus. The ensuing hyperglycaemia leads to osmotic diuresis, which itself leads to dehydration and haemoconcentration, and a vicious cycle begins. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. Combined with the insufficiency of insulin effect, there is an increase in counterregulatory hormone levels, including glucagon, cortsol, catecholamines, and growth hormone. Use of the va and stanford namelogos is only to indicate my academic.
Type 1 diabetes, also called insulin dependent diabetes mellitus iddm, is caused by lack of insulin secretion by beta cells of the pancreas. Hyperosmolar hyperglycemic state pathophysiology wikidoc. Apr 15, 2018 dka vs hhs dka means diabetic ketoacidosis and hhs means hyperosmolar hyperglycemic syndrome. Hyperosmolar hyperglycaemic state symptoms, diagnosis and. Clinical presentation, diagnosis, and treatment diabetes care 2014. Diabetes mellitus type 1 is a form of diabetes mellitus that results from the autoimmune destruction of the insulin producing betacells in the pancreas. Diabetic ketoacidosis and hyperglycemic hyperosmolar state risk factors for dka in patients with known dia betes include insulin omission, poor metabolic control, previous episodes of dka, gastroenteritis with per. Patients admitted to icu via ed with hhs hyperosmolar hyperglycemic state will be monitored and. Diabetic ketoacidosis is defined by a triad of hyper. 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. 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%.
Its more common in older people who have type 2 diabetes symptoms may begin gradually and worsen over a few days or weeks. 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. 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. Students examine a case study of a woman with a family history of diabetes and create a family health portrait that will assess her risk of developing type 2 diabetes. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Risk calculators and risk factors for hyperosmolar hyperglycemic state pathophysiology. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis. Management of the hyperosmolar hyperglycaemic state hhs in. In collaboration with the centers for disease control and preventions paula yoon.
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