Hyperosmolar hyperglycemic state is a lifethreatening emergency. Division of endocrinology, boston childrens hospital, boston, ma, usa. Overview of the diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs episode of care 1. We present a thin toddler whose initial presentation with type 1 diabetes was hyperglycemic hyperosmolar syndrome without diabetic ketoacidosis after ingestion of. 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. Test them regularly using a glucometer, work with your doctor to make sure youre taking any diabetes medications as prescribed, and learn the warning signs of elevated glucose levels and dehydration, such as extreme thirst and frequent urination, so you know to.
Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped. Hyperosmolar hyperglycemic state what you need to know. Emergency department management of diabetic ketoacidosis and. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Chapter 11 in ispad clinical practice consensus guidelines 2014. Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. The condition most commonly occurs in people with type 2 diabetes. Dec 01, 2017 hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. The complete set of guidelines can be found for free download.
Jul 12, 2014 this article is a chapter in the ispad clinical practice consensus guidelines 2014 compendium. A consensus statement from the international society for pediatric and adolescent diabetes. Hyperosmolar hyperglycemic state an overview sciencedirect. Diabetic ketoacidosis and hyperglycemic hyperosmolar state wolfsdorf ji, allgrove j, craig me, edge j, glaser n, jain v, lee wwr, mungai lnw, rosenbloom al, sperling ma, hanas r.
This article is published with open access at abstract. This article is a chapter in the ispad clinical practice consensus. Implications for nurse practitioners in primary care. 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. Hyperosmolar hyperglycaemic state hhs is a diabetic emergency that although typically occurring in. Many episodes could be prevented through education and effective outpatient treatment programs. Neurologic abnormalities frequently present coma in 2550% of cases. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Jul 12, 2014 diabetic ketoacidosis and hyperglycemic hyperosmolar state.
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%. Landsberg md, in clinical practice manual for pulmonary and. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Hospitalizations for hyperosmolar hyperglycemic nonketotic syndrome as firstlisted diagnosis in adults with diabetes, united states. 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. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. I n t r o d u c t i o n diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs represent two extremes in the spectrum of decompensated diabetes. In the majority of patients, hyperosmolar hyperglycemic state evolves over several days and so frequent blood glucose monitoring may help to recognize patients at risk, especially in older patients and in those in longterm care facilities. Hyperosmolar hyperglycemic state hhs endocrine and. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. Umpierrez the hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients.
Hyperosmolar hyperglycemic state hhshonc diabetic ketoacidosis adult diabetic ketoacidosis peds cerebral edema in dka. Hyperosmolar hyperglycemic state symptoms, diagnosis and. 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. Test them regularly using a glucometer, work with your doctor to make sure youre taking any diabetes medications as prescribed, and learn the warning signs of elevated glucose levels and dehydration, such as extreme thirst and frequent urination, so you know to seek treatment when you need it. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs. The hyperosmolar hyperglycemic state hhs is the most serious acute hypergly. 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. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious and lifethreatening hyperglycemic emergencies in patients with diabetes. 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 dka and the hyperosmolar hyperglycemic state hhs are the. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose. Hhns is an emergency caused by very high blood sugar, often over 600 mgdl. Pdf hyperglycaemic hyperosmolar state hhs in children. Pdf the hyperosmolar hyperglycemic state hhs is the most serious acute.
Hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Umpierrez the hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. The management of the hyperosmolar hyperglycaemic state in. Hyperosmolar hyperglycemic state diabetes care american. Novel advances in the management of hyperglycemic crises uk versus usa ketan k. Metabolic and clinical aspects third edition, 2014. The management of the hyperosmolar hyperglycaemic state hhs.
Diabetic ketoacidosis and hyperosmolar hyperglycemic. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome hhns. The goals of treatment are to provide frequent patient monitoring, to treat the underlying cause and to gradually and safely. Diagnosis and management of hyperglycemic emergencies. Hyperosmolar hyperglycaemic state symptoms, diagnosis and. Uncovering the precipitating event is critical to management, as morbidity and mortality are related more to the trigger than the dkahhs itself. When your blood sugar gets too high, the kidneys try to. Your body gets rid of the extra sugar through your urine.
This article is a chapter in the ispad clinical practice consensus guidelines 2014 compendium. 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. Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. Like diabetic ketoacidosis, hyperosmolar hyperglycemic state syndrome is not a disease perse, but more of a consequence to another pathology that is associated with an increase in the levels of the counterregulatory hormones. Hyperosmolar hyperglycemic state without ketosis in a. Hyperglycemic emergencies diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are common presentations in the ed that require swift, specialized management strategies. Although dka and hhs are often discussed as separate entities, they represent points along a spectrum of hyperglycemic emergencies due to poorly controlled diabetes. Home july 2014 volume 30 issue 7 hyperosmolar hyperglycemic state without ketosis in a toddle. Treatment of diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs. 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. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. Diabetic ketoacidosis and hyperglycemic hyperosmolar state risk factors for dka in patients with known diabetes include insulin omission, poor metabolic control, previous episodes of dka, gastroenteritis with persistent vomiting and inability to maintain hydration, psychiatric including eating disorders, challenging.
Ar scott 1 on behalf of the joint british diabetes societies for inpatient care 2 and the joint british diabetes societies hyperosmolar hyperglycaemic state guidelines group 3. Overview of the diabetic ketoacidosis dka hyperglycemic. Diabetic hyperosmolar syndrome symptoms and causes mayo. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Treatment of diabetic ketoacidosis dkahyperglycemic. The management of the hyperosmolar hyperglycaemic state. Hyperglycemic hyperosmolar syndrome hhs is a potentially life threatening condition involving extremely high blood sugar glucose levels. The best way to prevent hhns is by keeping your blood sugar levels under control. Hyperosmolar hyperglycemic state prevention bmj best practice. In children and adolescents, hyperosmolar hyperglycemic state. 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. Hyperglycemic hyperosmolar state used to be named hyperglycemic hyperosmolar nonketotic coma, but this term was not applicable to all patients as it was found that it frequently presents without coma.
Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus dm characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. A case of a patient with hyperosmolar hyperglycemic state. The management of the hyperosmolar hyperglycaemic state in adults with diabetes. View the article pdf and any associated supplements and figures for a. Hyperosmolar hyperglycemic state american family physician. The complete set of guidelines can be found for free download at the evidence grading system used in the ispad guidelines is the same as that used by the american diabetes association. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. Hyperosmolar hyperglycemic state prevention bmj best. Diabetes state burden toolkit centers for disease control. Infection is the most common cause of hyperosmolar hyperglycemic state. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. It most often occurs in type 2 dm, often in the setting of physiologic stress. 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. They each represent an extreme in the hyperglycemic spectrum.
Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine. Appropriate individualized acute management of these conditions typically results in satisfactory clinical outcomes and may decrease the mortality rate from up to 20% in type 2 diabetics with hyperglycemic hyperosmolar state vs less than 2% in patients with dka. Although the national estimates are reported at the annual level, the years of data vary across states 2011 2014. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. Hyperosmolar hyperglycaemic state symptoms, diagnosis. These results suggest the need to improve knowledge translation strategies across canadian emergency departments to standardize management of diabetic ketoacidosis and hyperosmolar hyperglycemic states and support the highest quality of patient care, as well as to ensure that future guidelines include management strategies applicable to the. Hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus.
974 123 555 160 562 1521 671 616 1130 469 391 1363 628 450 675 727 1318 687 1166 30 1041 742 1217 537 297 453 369 1358 855 1029 245 1366