Hyperosmolar Hyperglycemic Nonketotic Syndrome, or HHNS, is a serious condition most frequently seen in older persons. HHNS can happen. Hyperosmolar hyperglycemic state is a life-threatening emergency manifested by marked eleva- ADA = American Diabetes Association. Hyperosmolar hyperglycemic state is a life-threatening emergency on recommendations from the American Diabetes Association (Figure 2).

Author: Kazrakora Mooguzilkree
Country: Niger
Language: English (Spanish)
Genre: Music
Published (Last): 24 June 2017
Pages: 82
PDF File Size: 1.15 Mb
ePub File Size: 4.88 Mb
ISBN: 613-2-62888-815-1
Downloads: 20564
Price: Free* [*Free Regsitration Required]
Uploader: Kigazuru

BMJ Best Practice

Identification of factors that precipitated DKA or HHS during the index hospitalization should help prevent subsequent episode of hyperglycemic crisis. It may result from osmotically driven movement of water into the central nervous system when plasma hyperpsmolar declines too rapidly during treatment of DKA or HHS.

The American journal of emergency medicine ; 5: Once hypotension improves, the corrected serum sodium level is calculated.

Maletkovic J, Drexler A. Management of adult diabetic ketoacidosis. Management of hyperglycemic crises in patients with diabetes.

Hyperosmolar Hyperglycemic State – – American Family Physician

Learn the top 3 questions to ask your doctor about the link between type 2 diabetes and cardiovascular disease. Take a look at our subscription options.

Clinically, cerebral edema is characterized by deterioration in the level of consciousness, lethargy, decreased arousal, and headache.

Abdominal pain in patients with hyperglycemic crises. Hyperglycemia The hyperglycemia in DKA is the result of three events: Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis.

Acta Diabetol Lat ; Therefore, elevated pancreatic enzymes may not be reliable for the diagnosis of pancreatitis in the DKA setting. View this chapter in Endotext. In addition, they may have a propensity to use illicit drugs such as cocaine, which has been associated with recurrent DKA 45or live in areas with higher food deprivation risk Hyperosmolar hyperglycemic state is a life-threatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis.


Know the warning signs of HHNS. Furthermore, muscle hypdrosmolar is catabolized to lactic acid via glycogenolysis. Diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome. Thrombotic conditions and disseminated intravascular coagulation may contribute to the morbidity and mortality of hyperglycemic emergencies Several studies on serum osmolarity and mental alteration have established a positive hyperosmolsr relationship between osmolarity, pH and mental obtundation HHNS is usually brought on by something else, such as an illness or infection.


Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis. Lever E, Jaspan JB.

Subscription required

Hyperglycemic coma after suprasellar surgery. Get Started with Team Diabetes – diy-fundraising. Similar articles in PubMed. It should be emphasized that urinary losses of water and electrolytes are also need to be considered.

Diabetic ketoacidosis and hyperglycemic hyperosmolar coma. Hypoxemia and rarely non-cardiogenic pulmonary edema may complicate the treatment of DKA []. False positive values for lipase may be seen if plasma glycerol levels are very high due to rapid breakdown of adipose tissue triglycerides glycerol is the product measured in most assays for plasma lipase.

DKA usually evolves rapidly within a few hours of the precipitating event s. An 8-year study in schools and private practices. The administration of insulin without fluid replacement in such patients may further aggravate hypotension Adapted from Kitabchi et al. The case for venous rather than arterial blood gases in diabetic ketoacidosis. C 6 Phosphate replacement should be considered in patients with HHS only if hypophosphatemia is severe less than 1. Once dehydration is partially corrected, adults should receive an initial bolus of 0.

Furthermore drugs that have sulfhydryl groups can interact with the reagent in the nitroprusside reaction, giving a false positive result If desirable glucose reduction is not achieved in the first hour, an additional insulin bolus at 0. Elevated levels of pro-inflammatory cytokines and lipid peroxidation markers, as well as procoagulant factors such as plasminogen activator inhibitor-1 PAI-1 and C-reactive protein CRP have been demonstrated in DKA. Choose one of the access methods below or take a look at our subscribe or free trial options.


The best way to avoid HHNS is to check your blood sugar regularly. Annals of internal medicine ; The common clinical presentation of DKA and HHS is due to hyperglycemia and include polyuria, polyphagia, polydipsia, weight loss, weakness, and physical signs of intravascular volume depletion, such as dry buccal mucosa, sunken eye balls, poor skin turgor, tachycardia, hypotension and shock in severe cases.

Close observation, early detection of symptoms and appropriate medical care would be helpful in preventing HHS in the elderly.

There are also case reports of patients with DKA as the primary manifestation of acromegaly The administration of continuous IV infusion of regular insulin is the preferred route because of its short half-life and easy titration and the delayed onset of action and prolonged half-life of subcutaneous regular insulin.

Diabetic ketoacidosis is also characterized by increased gluconeogenesis, lipolysis, ketogenesis, and decreased glycolysis Medications should be reviewed to identify any that may precipitate or aggravate HHS; these medications should be discontinued or reduced. The initial laboratory evaluation of patients with suspected DKA or HHS should include determination of plasma glucose, blood urea nitrogen, serum creatinine, serum ketones, electrolytes with calculated anion gaposmolality, urinalysis, urine ketones by dipstick, arterial blood gases, and complete blood count with differential.

Diabetic ketoacidosis and infection: Determinants of plasma potassium levels in diabetic ketoacidosis. Ann Emerg Med ; Preventing a drop in effective plasma osmolality to minimize the likelihood of cerebral edema during treatment of children with diabetic ketoacidosis.