Hhnkc is a lifethreatening condition that can happen to people with either type 1 or type 2 diabetes when the disease is not being controlled properly, but it occurs more often in people with. The sudden increased level of sugar result in hypotension and tachycardia, complicating into coma and death. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction.
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 diabetic hyperosmolar syndrome can lead to. Without prompt treatment, diabetic hyperosmolar syndrome can be fatal. Hyperglycemic hyperosmolar nonketotic syndrome medind. Complications may include seizures, disseminated intravascular coagulopathy. Evidencebased management of hyperglycemic emergencies in diabetes mellitus. Hyperosmolar hyperglycemic state diabetes care american. Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. The brightest part of the coma is the central region nearest the surface of the nucleus, where the density of material being released is at.
Umpierrez and others published hyperglycemic crises. Good daily control of your diabetes can help you prevent diabetic hyperosmolar syndrome. The terms hyperglycemic hyperosmolar nonketotic state and hyperglycemic hyperosmolar nonketotic coma have been replaced with the term hyperglycemic hyperosmolar state hhs to highlight that 1 the hyperglycemic hyperosmolar state may consist of moderate to variable. Hyperglycemic hyperosmolar nonketotic syndrome ohanlonnichols, theresa rn, cs, cen, phd american journal of nursing. Finally, a direct role of hyperosmolarity by inhib iting lipolysis and free fatty acid release from adipose tissue has been shown in experimental animals 36. Hyperosmolar hyperglycaemic state symptoms, diagnosis. Hyperosmolar hyperglycemic nonketotic syndrome, or hhns, is a serious condition most frequently seen in older persons. What is hyperglycemic hyperosmolar nonketotic coma. Abstract a 24yearold juvenile diabetic with many episodes of diabetic ketoacidosis presented with hyperglycemic, hyperosmolar, nonketotic coma that progressed rapidly to death despite vigorous conventional. Hyperosmolar nonketotic state hhs or coma happens in people with diabetes.
Hyperosmolality and dehydration have also been reported to inhibit release of free fatty acids from adipose tissue. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Hyperosmolar hyperglycemic state hhs endocrine and. Hyperglycemic hyperosmolar nonketotic syndrome hhns is an emergency that the diabetes mellitus dm patient may. Diabetic ketoacidosis and hyperglycemic hyperosmolar. It consists of a diffuse luminous nebulous cloud of gas and dust that surrounds the comets nucleus and is formed by the sublimation of ices and ejection of dust particles from the nucleus.
Hyperosmolar hyperglycemic syndrome hhs is a clinical condition. Hyperosmolar hyperglycemic nonketotic syndrome and. 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. Hyperglycemic hyperosmolar nonketotic coma hhnkc is an extremely serious complication of type 2 diabetes, most often occurring in those who are noninsulin dependent. 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. See also hyperglycemic hyperosmolar nonketotic coma. Full text get a printable copy pdf file of the complete article 907k, or click on a page image below to browse page by page. Hyperglycemic hyperosmolar syndrome in the pediatric patient. Issue 2 nonketotic hyperosmolar coma with hyperglycemia.
Hyperosmolar hyperglycemic state linkedin slideshare. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed. In both syndromes, there is insufficient insulin levels to transport. In children and adolescents, hyperosmolar hyperglycemic state. Registered users can save articles, searches, and manage email alerts. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome the two most common lifethreatening complications of diabetes mellitus include diabetic ketoacidosis dka and hyperglycemic hyperosmolar syndrome hhs. 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. Panciera, in fluid, electrolyte, and acidbase disorders in small animal practice fourth edition, 2012. Diabetic ketoacidosis and the hyperglycemic hyperosmolar state are potentially fatal hy perglycemic crises that occur as acute complications of uncontrolled diabetes mellitus. Free water deficit is more pronounced in hhs, as compared with dka. 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 management of the hyperosmolar hyperglycaemic state hhs. The most obvious part of a comet when it is close to the sun. Understanding the presentation of hyperglycemic hyperosmolar nonketotic syndrome. Hyperosmolar definition of hyperosmolar by the free.
It can occur as a complication of borderline and unrecognized diabetes mellitus, in. 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. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness.
Hyperosmolar definition of hyperosmolar by medical. The discovery of insulin in 1921 changed the life expectancy of patients with diabetes. Five cases are described, in all of which excessive consumption of lucozade, a proprietary glucose drink, played an important part in the development of their hyperosmolar state. 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 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 free. Diabetic ketoacidosis and hyperglycemic hyperosmolar state find, read and cite all the research. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes. Hhns can happen to people with either type 1 or type 2 diabetes, but it occurs more often in people with type 2. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped. Hyperosmolar nonketotic coma article about hyperosmolar. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Hyperosmolar hyperglycemic state winchester hospital. 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. 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. Formerly named hyperglycemic hyperosmolar nonketotic coma, hyperglycemic hyperosmolar state hhs is defined as diabetes mellitus with a blood glucose concentration greater than 600 mgdl and serum osmolality more than 350 mosmkg in the absence. Register for a free account existing user log in existing user log in. Also referred to as hyperosmolar hyperglycemic state hhs, nonketotic hyperosmolar coma nkhoc is an acute complication of diabetes meillitus type 2.