Hyperosmolar hyperglycemic state diabetes care american. Hyperosmolar hyperglycemic state clinical presentation. The condition most commonly occurs in people with type 2 diabetes. Management of hyperosmolar hyperglycaemic state in adults. Diabetic hyperosmolar syndrome symptoms and causes mayo. The guideline must be adapted to the clinical situation where necessary. Hyperosmolar hyperglycemic state hhs endocrine and. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. Although there are multiple precipitating causes, underlying infections are the most common. The aim of jbdsip is to improve inpatient diabetes care throughout the uk. 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.
Overview of the diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs episode of care 1. 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. 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. 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. In the elderly, the presentation of hyperosmolar hyperglycaemic state hhs can be remarkably nebulous, with a poorly defined general deterioration in wellbeing. 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 hyperglycaemic hyperosmolar state hhs and hypoglycaemia are serious complications of diabetes mellitus that require prompt recognition, diagnosis and treatment. Joint british diabetes societies jbds 2012 aug pdf, summary of report can be found in diabet med 2015 jun. In both syndromes, there is insufficient insulin levels to transport. The management of the hyperosmolar hyperglycaemic state hhs. Hyperosmolar hyperglycemic nonketotic syndrome hhns.
Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed. Intravenous regular insulin is used to treat hyperglycemia. Management of the hyperosmolar hyperglycaemic state hhs. The management of the hyperosmolar hyperglycaemic state in. Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with. The criteria for hyperglycemic hyperosmolar state hhs include.
This syndrome was previously referred to as hhns or honk, an abbreviation for hyperglycemic hyperosmolar nonketotic state. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. While there are no distinct imaging features, it is useful for a radiologist to be familiar with this condition. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. 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. Diabetic ketoacidosis and hyperglycemic hyperosmolar. Hyperosmolar hyperglycemic state, diabetic hhs vs dka. All management must be recorded in adult hyperosmolar hyperglycaemic state guidelines and management record mr 838, see appendix 1.
Hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus. 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. Downloadmanagement of the hyperosmolar hyperglycaemic state hhs in adults with diabetes pdf, 3mb. 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. Management of the hyperosmolar hyperglycaemic state hhs in. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes. The management of hyperosmolar hyperglycaemic state hhs in adults with diabetes. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. May 29, 2019 diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Hyperosmolar hyperglycemic state radiology reference. Diabetic ketoacidosis dka and hyperosmolar hyperglycaemic. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Racgp hyperglycaemic presentations in type 2 diabetes. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome.
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. 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%. Dec 23, 2015 hyperosmolar hyperglycaemic state hhs occurs in people with type 2 diabetes. Pdf the hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes.
Role of cha 2 ds 2vasc score in predicting newonset atrial fibrillation in patients with type 2 diabetes mellitus with and without hyperosmolar hyperglycaemic state. This guideline is intended for use in managing hyperglycaemic hyperosmolar state hhs for all children and young people up to the age of 18 years with diabetes mellitus. Staff must adhere to the following procedure when managing an adult patient with hyperosmolar hyperglycaemic state hhs. Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. Overview of the diabetic ketoacidosis dka hyperglycemic. V2 approved by policy and guideline committee on 29 november 2019 trust ref. Hyperosmolar hyperglycemic state hhs, also known as nonketotic hyperglycemic hyperosmolar syndrome nkhs, is characterized by profound hyperglycemia glucose 600 mgdl, hyperosmolality effective serum osmolality.
Hhs is different from diabetic ketoacidosis dka and treatment requires a different approach. It is less common than the other acute complication of diabetes, diabetic ketoacidosis dka. The present article summarizes the recent guidance on. It can also occur in people with type 1 diabetes, but less commonly. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. Hyperosmolar hyperglycemic state winchester hospital. May 06, 2020 role of cha 2 ds 2vasc score in predicting newonset atrial fibrillation in patients with type 2 diabetes mellitus with and without hyperosmolar hyperglycaemic state. 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. Feb 03, 2020 hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Hyperosmolar hyperglycemic state what you need to know. The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of.
It can develop over a course of weeks through a combination of illness e. Hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Hyperosmolar hyperglycaemic state symptoms, diagnosis. Diabetic ketoacidosis and the hyperglycemic hyperosmolar nonketotic state. Hyperosmolar hyperglycemic state is diagnosed by severe hyperglycemia. The joint british diabetes societies for inpatient care have recently provided guidance on the management of hyperosmolar hyperglycaemic state hhs, a medical emergency which differs from diabetic ketoacidosis dka through higher mortality and potential for complication by myocardial infarction, stroke, seizures, cerebral oedema and central. Clinical guideline practical management of hyperglycaemic. Hyperosmolar hyperglycaemic state hhs in adults uhl guideline. While dka is a state of near absolute insulinopenia, there is sufficient amount of insulin present in hhs to prevent lipolysis and ketogenesis but not adequate to cause glucose utilization as it takes 110 as much insulin to suppress lipolysis as it does to stimulate glucose utilization 26,27. Introduction hyperglycaemic hyperosmolar state hhs, previously known as hyperosmolar.
This is mainly through the development and use of high quality evidence based guidelines, and through better inpatient care pathways. Hyperosmolar hyperglycemic state hhs previously known as hyperosmolar nonketotic coma honk is a serious metabolic derangement that can occur in patients with diabetes mellitus, predominantly those with type 2. Hyperosmolar hyperglycemic state inpatient care what you. Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus dm characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Hyperosmolar hyperglycemic state symptoms, diagnosis and. It is very serious, but uncommon disorder seen typically in people with type 2 diabetes. The management of the hyperosmolar hyperglycaemic state.
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. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. May 17, 2015 hyperglycaemic hyperosmolar state hhs is a medical emergency, which differs from diabetic ketoacidosis dka and requires a different approach. Hyperosmolar hyperglycaemic state hhs is a diabetic emergency that.
Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. Your body gets rid of the extra sugar through your urine. Hyperosmolar hyperglycaemic state hhs occurs in people with type 2 diabetes who experience very high blood glucose levels often over 40mmoll. Chqgdl60016 diabetic ketoacidosis dka and hyperosmolar hyperglycaemic state hhs emergency management in children 3 hyperglycaemic hyperosmolar state hhs hhs is a state of extreme hyperglycaemia and hence hyperosmolality without ketosis which is usually, but not exclusively, seen in type 2 diabetes. Compared with dka, these people present with more severe dehydration, hyperglycaemia and more serious comorbidities. Hyperosmolar hyperglycaemic state hhs, however, is a potentially lifethreatening metabolic derangement that occurs in t2dm as a result of severe hyperglycaemia.
It most often occurs in type 2 dm, often in the setting of physiologic stress. 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 pdf, summary of report can be found in diabet med 2015 jun. Hyperosmolar hyperglycemic state american family physician. This used to be called hyperosmolar nonketotic state honk. Diabetic emergencies ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. Very high blood glucose levels often over 40 mmoll develop as a result of a combination of illness, dehydration and an inability to take normal diabetes medication due to the effect of illness. Dec 01, 2017 hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. Hyperosmolar hyperglycaemic state symptoms, diagnosis and. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. Hyperosmolar hyperglycemic state seen in type 2 diabetes mellitus more neurologic symptoms. Hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm.
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