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. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome management emergency medicine. A persons breath may develop a specific fruity smell. 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. Buildup of ketones in the body ketoacidosis may also occur. The aim of this study was to establish a standardized approach to the initial care of patients with diabetic ketoacidosis dka and hyperglycaemic hyperosmolar syndrome hhs. It is less common than the other acute complication of diabetes, diabetic ketoacidosis dka. Dka diabetic ketoacidosis hyperosmolar syndrome hhs hyperglycemic for adults with type diabetes sick day management for children with type diabetes sick day management m oh o oh oh o oh oh o oh why do blood glucose values go up when someone with type 1 diabetes is sick. Diabetic ketoacidosis may occur in those previously known to have diabetes mellitus type 2 or in those who on further investigations turn out to have features of type 2 diabetes e. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Request pdf diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome studies in african american patients with diabetic ketoacidosis dka and. Diabetic ketoacidosis and hyperglycemic hyperosmolar state table 1. Jan 14, 2019 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. Neurologic and respiratory signs occurred frequently.
Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute. Dka is a series of events that starts with not having enough insulin for the present condition and leads to a serious imbalance in the blood. Optimal insulin deliv ery in diabetic ketoacidosis dka and hyperglycemic hyperosmolar nonketotic coma hhnc. The nursing care plan for clients with diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome includes provision of information about disease processprognosis, selfcare, and treatment needs, monitoring and assistance of cardiovascular, pulmonary, renal, and central nervous system cns function, avoiding dehydration, and. Hyperglycemic, hyperosmolar syndrome was seen in older cats that were often long. There were 846 episodes of ketoacidosis and 126 episodes of hyperosmolar state. Overview of the diabetic ketoacidosis dka hyperglycemic.
Hyperglycemic, hyperosmolar syndrome in feline diabetics. It is a consequence of a relative or an absolute insulin deficiency in combination with an excess of counterregulatory hormones primarily glucagon and catecholamines, but also cortisol and growth hormone. 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. Dka diabetic ketoacidosis hyperosmolar syndrome hhs hyperglycemic for adults with type diabetes sick day management for children with type diabetes sick day management m oh o oh oh o oh oh o oh what is dka. 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. 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. Dka is responsible for more than 500,000 hospital days per year 1,2 at an estimated annual direct medical expense and indirect cost of 2. How can you prevent hyperglycemic hyperosmolar nonketotic. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing. Hyperglycemic crises in adult patients with diabetes. Feb 17, 2019 to prevent hyperglycemic hyperosmolar nonketotic syndrome and diabetic coma in type 2 diabetes, check your blood sugar regularly as recommended by your health care provider, check your blood sugar.
Hyperglycemic hyperosmolar nonketotic syndrome occurs when the blood sugar gets too high and the body becomes severely dehydrated. 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 lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. 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 hyperglycemic hyperosmolar syndrome in children. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Their condition is then labeled ketosisprone type 2. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Arieff and carrolls diagnostic criteria included a blood glucose level. The condition most commonly occurs in people with type 2 diabetes. Dec 11, 2019 diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The authors report no actual or potential conflict of interest in relation to this article. Hhs are two acute complications of diabetes that can result in increased morbidity. But it is unusual and is often mild compared with diabetic ketoacidosis.
Diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs appear as 2 extremes in the spectrum of diabetic decompensation. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Dka diabetic ketoacidosis oh o hyperosmolar syndrome. Request pdf on jul 1, 2014, joseph i wolfsdorf and others published diabetic ketoacidosis and hyperglycemic hyperosmolar state find, read and cite all the. An annual audit of diabetic ketoacidosis and hyperosmolar nonketotic state was made in one hospital from 1971 to 1988. Diabetic ketoacidosis is defined by a triad of hyper glycemia or a diagnosis of diabetes, metabolic acidosis, and ketonemia table 1. Affects mainly type 1 diabetics ketonesand acidosis present hyperglycemia presents 300 mgdl variableosmolality happens suddenly causes. Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the two most serious acute metabolic complications of diabetes. Diabetic ketoacidosis and hyperosmolar hyperglycemic state. Diabetic ketoacidosis and hyperglycaemic hyperosmolar. May 29, 2019 diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Mar 19, 2004 hyperglycemic, hyperosmolar syndrome was seen in older cats that were often long. 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. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar nonketotic syndrome hhns are lifethreatening acute metabolic complications of diabetes mellitus.
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 hyperosmolar syndrome symptoms and causes mayo. The condition develops when your body cant produce enough insulin. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. Diabetic ketosis acidosis diabetes kills animals definitions dka. The terms hyperglycemic hyperosmolar nonketotic state and.
Diabetic ketoacidosis dka is a potentially lifethreatening complication of diabetes mellitus. Kitabchi, phd, md a department of medicine, emory university school of medicine, atlanta, georgia department of medicine, emory university. The goals of treatment are to provide frequent patient monitoring, to treat the underlying cause and to gradually and safely. Associated with elevated levels of counterregulatory hormones, insulin deficiency can trigger hepatic glucose production and reduced glucose uptake, resulting in.
Diabetic ketoacidosis dka and hyperosmolar hyperglycemic syndrome. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. Diabetic hyperglycemic hyperosmolar syndrome hhs is a complication of type 2 diabetes. Hyperosmolar hyperglycemic state symptoms, diagnosis and. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. Severe complications after initial management of hyperglycemic hyperosmolar syndrome and diabetic ketoacidosis with a standard diabetic ketoacidosis protocol. Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a consequence of the underlying precipitating causes rather. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening emergencies that occur in patients with type 1 diabetes and type 2 diabetes. Hyperglycemic crises in adult patients with diabetes diabetes care 2009 jul. What causes hyperglycemic hyperosmolar nonketotic syndrome. Evaluation at presentation revealed profound dehydration, lactic acidosis, and azotemia. To prevent hyperglycemic hyperosmolar nonketotic syndrome and diabetic coma in type 2 diabetes, check your blood sugar regularly as recommended by your health care provider, check your blood sugar. Diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome diabetic ketoacidosis.
Diabetic ketoacidosis and the hyperglycemic hyperosmolar state are the most serious complications of diabetic decompensation and remain associated with excess mortality. In new onset diabetes, dka is frequently the consequence of a delay in diagnosis e. 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. 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 symptoms and causes mayo clinic. Typically, dka presents in type i diabetics while hhs presents in type ii diabetics. Oct 26, 2017 hyperglycemic hyperosmolar syndrome hhs is a clinical entity not identical to diabetic ketoacidosis dka, and with a markedly higher mortality. Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction. Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a consequence of the underlying precipitating causes. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Supported in part by emory university medical care foundation grants 247050 and 246890 dr. In this study, we analyzed the prevalence, precipitating. Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a conse. Children with hhs can also present with concomitant dka.
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 lifethreatening emergency manifested by marked elevation of blood glucose. Client concerns included polydipsia, polyuria, and lethargy. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. They each represent an extreme in the hyperglycemic spectrum. 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 600 mgdl, hyperosmolality effective serum osmolality. 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. Chapter 11 in ispad clinical practice consensus guidelines 2014. 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 and hyperosmolar nonketotic syndrome. Hyperosmolar hyperglycemic state hhs endocrine and. Table 1 outlines the diagnostic criteria for dka and hhs.
Apr 12, 2019 the nursing care plan for clients with diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome includes provision of information about disease processprognosis, selfcare, and treatment needs, monitoring and assistance of cardiovascular, pulmonary, renal, and central nervous system cns function, avoiding dehydration, and. Diabetic ketoacidosis and hyperglycemic hyperosmolar. Insulin deficiency is the main underlying abnormality. Studies in african american patients with diabetic ketoacidosis dka and hyperglycemic hyperosmolar nonketotic syndrome hhns are sparse. Because the approach to the diagnosis and treatment of these hyperglycemic crises.
Hyperglycemic hyperosmolar syndrome hhs is a clinical entity not identical to diabetic ketoacidosis dka. 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. Diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs are potentially fatal hyperglycemic crises that occur as acute complications of. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. It involves extremely high blood sugar glucose level without the presence of ketones. Although there are some important differences, the pathophysiology, the presenting clinical challenge, and the treatment of these metabolic derangements are similar.
Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. Insulin normally plays a key role in helping sugar glucose a major source of energy for your muscles and other tissues enter your. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic syndrome hhs are. Diagnosis and treatment of diabetic ketoacidosis and the. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped. The criteria for hyperglycemic hyperosmolar state hhs include.
1426 803 1049 580 1520 1431 1225 596 899 1488 417 1005 1355 1632 1435 1009 150 248 837 473 499 388 1168 1078 1100 1457 389 1104 498 205 694 169 341