Hyperosmolar hyperglycemic nonketotic syndrome how to. Hyperglycemic hyperosmolar nonketotic syndrome hhns is a potentially deadly condition that can develop as a result of infection or illness in people with uncontrolled type 2 diabetes or when diabetes medications arent taken as directed. Hyperglycemic hyperosmolar nonketotic syndrome researchgate. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs.
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. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. The epidemiology and the factors responsible for the metabolic abnormalities of dka and. Hhns stands for hyperglycemic hyperosmolar nonketotic syndrome. Medically speaking, it is a serious condition where the body has to face severe damage to many of its organs and in. Following is a list of causes or underlying conditions see also misdiagnosis of underlying causes of hyperglycemic hyperosmolar nonketotic syndrome that could possibly cause hyperglycemic hyperosmolar nonketotic syndrome includes. The exact incidence of hhs is not known, but it is estimated to account for hyperosmolar hyperglycemic nonketotic syndrome as firstlisted diagnosis in adults with diabetes, united states. Hyperosmolar hyperglycaemic state hhs is a diabetic emergency that. 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. Hyperglycemic hyperosmolar syndrome in children diabetes. It involves extremely high blood sugar glucose level without the presence of ketones.
Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus t2 dm and its incidence is likely to go up, given global increase in incidence of childhood obesity, increased insulin resistance, and t2 dm. Diagnostic tests for hyperglycemic hyperosmolar nonketotic. Remember that the cell has two options for getting energy. Patients admitted to icu via ed with hhs hyperosmolar hyperglycemic. Generally, hhs isnt associated with significant ketoacidosis. Diabetic ketoacidosis and hyperosmolar hyperglycemic state.
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. Concepts of fluid therapy in diabetic ketoacidosis and hyperosmolar hyperglycemic nonketotic coma. In hyperosmolar dehydration due to enteric disease, hyperglycemia may occur with or without elevation of the serum acetone level or sodium level or both. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. Risk factors for dka in patients with known dia betes include insulin omission, poor metabolic. Hyperglycemic hyperosmolar nonketotic syndrome with. The management of the hyperosmolar hyperglycaemic state hhs. Now it is being diagnosed with increasing frequency in. Hyperosmolar hyperglycemic nonketotic syndrome hhns. Hyperosmolar hyperglycemic state hhs endocrine and.
The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis. Hyperglycemia without ketosis or hypernatremia jama pediatrics. Hyperglycemic hyperosmolar nonketotic syndrome hhns is one of the most severe acute complications of diabetes. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Avoiding hyperglycemic hyperosmolar nonketotic syndrome. Management of the hyperosmolar hyperglycemic syndrome. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Pathophysiology hhns occurs in type 2 diabetics when the body is unable to excrete excess sugar in the blood.
Get medical help right away if you have any of these warning signs. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Hyperglycemic hyperosmolar, nonketotic coma, type 2 diabetes mellitus. Management of the hyperosmolar hyperglycemic syndrome a more recent article on hyperosmolar hyperglycemic state is available. Hyperglycemic hyperosmolar syndrome at the onset of type 2. 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. 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.
Hhs occurs when a persons blood glucose sugar levels are too high for a long period, leading to severe dehydration extreme thirst and confusion. Course and prognosis of 2 patients with diabetic non ketotic hyperosmolar state. But it is unusual and is often mild compared with diabetic ketoacidosis. 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. Hyperosmolar nonketotic syndrome with hypernatremia. 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. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped.
Its considered an acute exacerbation of type 2 diabetes mellitus. The blood becomes very concentrated hyperosmolar, but does not produce ketones. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. Hyperosmolar hyperglycaemic state symptoms, diagnosis. Hhns can affect both types of diabetics, yet it usually occurs amongst people with type 2 diabetes usually, hhns is brought on by an illness or infection. The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Hyperosmolar hyperglycemic nonketotic syndrome hhns mostly affects elderly people. It is less common than the other acute complication of diabetes, diabetic ketoacidosis dka. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels.
The list of diagnostic tests mentioned in various sources as used in the diagnosis of hyperglycemic hyperosmolar nonketotic syndrome includes. Over time, you pee less, but when you do, its very dark. Diabetic hyperglycemic hyperosmolar syndrome hhs is a complication of type 2 diabetes. List of causes of hyperglycemic hyperosmolar nonketotic syndrome. 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 hyperosmolar hyperglycemic nonketotic coma hhnc, hyperosmolar hyperglycemic nonketotic syndrome. Arieff and carrolls diagnostic criteria included a blood glucose level.
The condition most commonly occurs in people with type 2 diabetes. 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 hyperosmolar hyperglycemic state hhs, also known as hyperosmotic hyperglycemic nonketotic state hhnk are two of the most serious acute complications of diabetes. Blood sugar test check for very high blood sugars symptom analysis. Diabetic hyperosmolar syndrome symptoms and causes. 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 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. The hyperosmolar hyperglycemic nonketotic syndrome is also one such disease which is actually an advanced stage of type 2 diabetes. Nonketotic hyperosmolar syndrome is a complication seen in diabetes mellitus in which very marked hyperglycemia occurs such as levels exceeding 800 mgdl, causing osmotic shifts in water in brain cells, and resulting in coma. Diabetic ketoacidosis and hyperglycemic hyperosmolar. Hyperosmolar hyperglycemic syndrome hhs is a serious complication of diabetes mellitus.
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. Hyperosmolar hyperglycemic syndrome diagnosis and tests. Hyperglycemic hyperosmolar syndrome hhs is a potentially life threatening condition involving extremely high blood sugar glucose levels. They each represent an extreme in the hyperglycemic spectrum. 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 hyperosmolar hyperglycemic state hhs, also called hyperosmotic hyperglycemic nonketotic state hhnk are two of the most serious acute complications of diabetes. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Buildup of ketones in the body ketoacidosis may also occur. So that gives us a bit of a hint as to whats going on, right. Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a consequence of the underlying precipitating causes. Some hhs patients experience coma, and others have only mild ketosis.
Hyperglycemic hyperosmolar state hhs is rare in the paediatric population. Causes of hyperglycemic hyperosmolar nonketotic syndrome. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute. It can be fatal or lead to permanent neurologic damage. Hyperglycemic hyperosmolar nonketotic syndrome medind. Hyperglycemia, hyperosmolar nonketotic syndrome in children. What is hyperosmolar hyperglycemic nonketotic syndrome hhns. 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 syndrome hhs, charac terized by extreme elevations in serum glucose concen trations and hyperosmolality without significant. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. Initially, it causes polyuria, frequent urination, but as it progresses.
Hyperosmolar hyperglycemic syndrome cleveland clinic. For this reason, many clinicians prefer the term hyperosmolar hyperglycemic syndrome because it reflects the two primary. The terms hyperglycemic hyperosmolar nonketotic state and. What are the warning signs of hyperosmolar hyperglycemic. Hyperglycemic hyperosmolar nonketotic syndrome occurs at a frequency of 17. This is a state of severe hyperglycemia, except without ketoacidosis.
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