Hyperosmolar hyperglycemic state inpatient care what you. 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. Your body gets rid of the extra sugar through your urine. 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. The management of the hyperosmolar hyperglycaemic state in. Overview of the diabetic ketoacidosis dka hyperglycemic. All management must be recorded in adult hyperosmolar hyperglycaemic state guidelines and management record mr 838, see appendix 1. Management of hyperosmolar hyperglycaemic state in adults. 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 hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. Diabetic ketoacidosis and hyperglycemic hyperosmolar. Introduction hyperglycaemic hyperosmolar state hhs, previously known as hyperosmolar. 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 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. It most often occurs in type 2 dm, often in the setting of physiologic stress. 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. Joint british diabetes societies jbds 2012 aug pdf, summary of report can be found in diabet med 2015 jun. 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.
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. Diabetic ketoacidosis and the hyperglycemic hyperosmolar nonketotic state. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed. Hyperosmolar hyperglycemic state what you need to know. Pdf the hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. The criteria for hyperglycemic hyperosmolar state hhs include.
Hyperosmolar hyperglycemic state symptoms, diagnosis and. 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 diabetes care american. Hyperosmolar hyperglycemic state hhs endocrine and. Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. It is less common than the other acute complication of diabetes, diabetic ketoacidosis dka. May 29, 2019 diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with 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. 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. Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. It is very serious, but uncommon disorder seen typically in people with type 2 diabetes. The present article summarizes the recent guidance on.
The condition most commonly occurs in people with type 2 diabetes. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Hhs is different from diabetic ketoacidosis dka and treatment requires a different approach. Hyperosmolar hyperglycemic state american family physician. Hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus dm characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. Overview of the diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs episode of care 1. In the elderly, the presentation of hyperosmolar hyperglycaemic state hhs can be remarkably nebulous, with a poorly defined general deterioration in wellbeing. Although there are multiple precipitating causes, underlying infections are the most common. Staff must adhere to the following procedure when managing an adult patient with hyperosmolar hyperglycaemic state hhs. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. The management of the hyperosmolar hyperglycaemic state hhs.
Hyperosmolar hyperglycemic state hhs, also known as nonketotic hyperglycemic hyperosmolar syndrome nkhs, is characterized by profound hyperglycemia glucose 600 mgdl, hyperosmolality effective serum osmolality. Hyperosmolar hyperglycemic state is diagnosed by severe hyperglycemia. The aim of jbdsip is to improve inpatient diabetes care throughout the uk. Hyperosmolar hyperglycemic state radiology reference. Hyperosmolar hyperglycaemic state hhs in adults uhl guideline. This is mainly through the development and use of high quality evidence based guidelines, and through better inpatient care pathways.
Hyperosmolar hyperglycaemic state hhs occurs in people with type 2 diabetes who experience very high blood glucose levels often over 40mmoll. Compared with dka, these people present with more severe dehydration, hyperglycaemia and more serious comorbidities. Diabetic ketoacidosis dka and hyperosmolar hyperglycaemic. V2 approved by policy and guideline committee on 29 november 2019 trust ref. The management of the hyperosmolar hyperglycaemic state. It can develop over a course of weeks through a combination of illness e. 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. It can also occur in people with type 1 diabetes, but less commonly. Hyperosmolar hyperglycemic state seen in type 2 diabetes mellitus more neurologic symptoms. Intravenous regular insulin is used to treat hyperglycemia. 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.
The management of hyperosmolar hyperglycaemic state hhs in adults with diabetes. Diabetic emergencies ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. 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. Hyperosmolar hyperglycemic state winchester hospital. Hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. In both syndromes, there is insufficient insulin levels to transport. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. This used to be called hyperosmolar nonketotic state honk. 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. The guideline must be adapted to the clinical situation where necessary. Downloadmanagement of the hyperosmolar hyperglycaemic state hhs in adults with diabetes pdf, 3mb. Hyperosmolar hyperglycemic state clinical presentation. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels.
Management of the hyperosmolar hyperglycaemic state hhs. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. The hyperglycaemic hyperosmolar state hhs is a medical emergency. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes. This syndrome was previously referred to as hhns or honk, an abbreviation for hyperglycemic hyperosmolar nonketotic state. Hyperosmolar hyperglycaemic state symptoms, diagnosis and. 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, diabetic hhs vs 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. Diabetic hyperosmolar syndrome symptoms and causes mayo. Hyperosmolar hyperglycemic nonketotic syndrome hhns. 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. 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.
May 17, 2015 hyperglycaemic hyperosmolar state hhs is a medical emergency, which differs from diabetic ketoacidosis dka and requires a different approach. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. 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 hyperglycaemic state symptoms, diagnosis. The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Management of the hyperosmolar hyperglycaemic state hhs in. 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 hyperglycaemic state hhs is a diabetic emergency that.
Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with. Hyperosmolar hyperglycaemic state hhs, however, is a potentially lifethreatening metabolic derangement that occurs in t2dm as a result of severe hyperglycaemia. 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%. Clinical guideline practical management of hyperglycaemic. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Dec 23, 2015 hyperosmolar hyperglycaemic state hhs occurs in people with type 2 diabetes. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels.
175 963 627 82 1115 1469 1475 797 1446 1022 647 179 619 1565 105 8 217 1090 704 108 337 652 391 342 172 1510 1051 600 445 519 851 203 1324 1074 923 1155 1181 67 1068 519 636 1213 846 1361 365 797