The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. Hyperosmolar hyperglycemic state what you need to know. In new onset diabetes, dka is frequently the consequence of a delay in diagnosis e. Diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs are potentially fatal hyperglycemic crises that occur as acute complications of uncontrolled diabetes mellitus. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. Your body gets rid of the extra sugar through your urine. 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. Hyperosmolar hyperglycaemic state hhs occurs in people with type 2 diabetes who experience very high blood glucose levels often over 40mmoll. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Hyperosmolar hyperglycemic state american family physician. Hyperosmolar hyperglycemic state hhs, also known as nonketotic hyperglycemic hyperosmolar syndrome nkhs, is characterized by profound hyperglycemia glucose 600 mgdl, hyperosmolality effective serum osmolality. Hospital admissions for hhs are lower than the rate for dka and accounts for less than 1 percent of all primary diabetic admissions. The goals of treatment are to provide frequent patient monitoring, to treat the underlying cause and to gradually and safely.
The management of the hyperosmolar hyperglycaemic state in adults with diabetes. 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. Hyperosmolar hyperglycemic state 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 diabetes care american. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. Patients admitted to icu via ed with hhs hyperosmolar hyperglycemic.
The hyperosmolar hyperglycemic state hhs is characterized by progressive hyperglycemia and hyperosmolarity typically found in a debilitated patient with poorly controlled or undiagnosed type ii diabetes mellitus dm, limited access to water, and commonly, a precipitating medical event. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Hyperosmolar hyperglycaemic state symptoms, diagnosis. Hyperosmolar hyperglycemic state hhs is a serious complication of diabetes characterized by serum hyperglycemia and hyperosmolarity, without ketoacidosis. View the article pdf and any associated supplements and figures for a period of 48 hours. The criteria for hyperglycemic hyperosmolar state hhs include. Hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. The management of hyperosmolar hyperglycaemic state hhs in adults with diabetes. Hyperglycaemic hyperosmolar state hhs is a medical emergency, which differs from diabetic ketoacidosis dka and requires a different approach. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. Changing the name to hyperosmolar hyperglycaemic state hhs allows for the fact that some people with severely raised blood glucose may. Management of hyperosmolar hyperglycaemic state in adults.
However, hhs is different and treatment requires a different approach. The management of the hyperosmolar hyperglycaemic state hhs. It is less common than the other acute complication of diabetes, diabetic ketoacidosis dka. Electrolytes losses sodium 7 to meq per kg chloride 3 to 7 meq per kg potassium 5 to 15 meq per kg phosphate 70 to 140 mmol per kg calcium 50 to 100 meq per kg magnesium 50 to 100 meq per kg water 100 to 200 ml per kg. Management of the hyperosmolar hyperglycaemic state hhs. Hyperosmolar hyperglycemic state clinical presentation. Strategies for medical management that are safe for both mother and fetus will be presented. 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 state hhs is the nomenclature recommended by the american diabetes association to emphasize the varying alterations in sensorium less than coma that are usually present in humans and that hhs may occur with mild ketosis and acidosis nugent, 2005. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed. Management of hyperosmolar hyperglycaemic state in adults with. 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. It can develop over a course of weeks through a combination of illness e. Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious and lifethreatening hyperglycemic emergencies in diabetes. Pdf the hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. It most often occurs in type 2 dm, often in the setting of physiologic stress. Hyperosmolar hyperglycemic state hhs endocrine and. Features of the 2 disorders with ketoacidosis and hyperosmolality may coexist. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes. Abstract hyperglycaemic hyperosmolar state hhs is a medical. The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of.
Although there are multiple precipitating causes, underlying infections are the most common. Hyperosmolar hyperglycaemic state hhs is a diabetic emergency that. 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. Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. The level of glucose in the blood must be restored to normal gradually to avoid sudden shifts of fluid within the brain. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. The anesthetic management of labor and delivery as well as operative deliveries will be discussed.
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 is a metabolic complication of diabetes mellitus dm characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state. 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. Hyperosmolar hyperglycemic state is treated much like diabetic ketoacidosis. 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. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. Electrolyte losses in hyperosmolar hyperglycemic state.
The hyperglycaemic hyperosmolar state hhs is a medical emergency. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with. 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. 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. Hyperosmolar hyperglycemic state hhs, sometimes labeled hyperosmolar nonketotic state or honk is much more common in type 2 diabetes and features increased plasma osmolarity above 320 mosmkg due to profound dehydration and concentration of the blood.
Hhs is different from diabetic ketoacidosis dka and treatment requires a different approach. Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction. Hyperosmolar hyperglycemic state hhs hhs and dka are of two of the most serious complications form diabetes. Diabetic ketoacidosis and hyperglycemic hyperosmolar. 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. Hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Unlike the other common diabetes emergency, diabetic ketoacidosis dka, guidelines on the management of the hyperglycaemic hyperosmolar state hhs in adults are uncommon and often there is little to differentiate them from the management of dka. Diabetic emergencies ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Hyperosmolar hyperglycemic state linkedin slideshare. 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. Intravenous regular insulin is used to treat hyperglycemia. Joint british diabetes societies jbds 2012 aug pdf, summary of report can be found in diabet med 2015 jun. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome the two most common lifethreatening complications of diabetes mellitus include diabetic ketoacidosis dka and hyperglycemic hyperosmolar syndrome hhs. Dka is more common in young people with type 1 diabetes and hhs in adult and elderly patients with type 2 diabetes.
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