Diagnosing and treating hyperglycemic hyperosmolar syndrome. Arieff and carrolls diagnostic criteria included a blood glucose level. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. Diabetic hyperglycemic hyperosmolar syndrome information. 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 syndrome that can occur in diabetics who produce enough insulin to prevent dka but not enough to prevent severe hyperglycemia, osmotic diuresis, and ecf depletion.
With hhs, an individual is hyperosmolar which means the chemical content of the blood is now dissolved in less than the normal amount of water due to reduced fluid intake. 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 dka and hyperglycemic hyperosmolar nonketotic syndrome hhns are lifethreatening acute metabolic complications of diabetes mellitus. Oct 27, 2012 hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. Hyperglycemic hyperosmolar nonketotic syndrome hhns caused by lack of insulin or insulin resistance with resulting hyperglycemia which causes osmotic diuresis. The condition most commonly occurs in people with type 2 diabetes. Diabetic ketoacidosis is defined by a triad of hyper glycemia or a diagnosis of diabetes, metabolic acidosis, and ketonemia table 1. Hyperglycemia, hypernatremia, and hyperosmolarity in 6. Unlike dka, which can be diagnosed when blood glucose also called blood sugar values are in the range of 250300 mgdl over a few hours, hhs is diagnosed when blood. Hyperglycemic hyperosmolar syndrome hhs, charac terized by extreme.
How to recognize and intervene for hyperosmolar hyperglycemic. The syndrome is characterized by severe hyperglycemia, a. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. If you continue browsing the site, you agree to the use of cookies on this website. Clinical signs of this syndrome include a fine head tremor, ataxia, and a basewide stance of the hind limbs, but biochemical analyses are necessary to confirm the diagnosis. Hyperosmolar hyperglycemic state clinical presentation. Hyperosmolar hyperglycemic state is diagnosed by severe hyperglycemia and plasma hyperosmolality and absence of significant ketosis. Hyperosmolar hyperglycemic syndrome occurs because as blood glucose levels go higher and higher, urine output goes up, and dehydration sets in. In 3040% of cases, hhs is the patients initial presentation of diabetes. Hyperglycemic hyperosmolar state endotext ncbi bookshelf. Treatment of patients with dka and hhs uses significant health care resources. Jan 14, 2019 most patients with hyperosmolar hyperglycemic state hhs have a known history of type 2 dm. Hyperosmolar hyperglycemic nonketotic syndrome hhns. Usually, hhns is brought on by an illness or infection.
Water shift from intracellular to intravascular compartment resulting in hypernatremia and increased osmolarity. It involves extremely high blood sugar glucose level without the presence of ketones. Management of hyperglycemic crises in patients with diabetes. See causes and risk factors by clicking the pdf icon above. Hyperglycemic hyperosmolar syndrome hhs is a critical complication of diabetes mellitus that requires immediate diagnosis and treatment. Hyperosmolar hyperglycemic state an overview sciencedirect. Treatment of hyperglycaemic hyperosmolar nonketotic syndrome. Hyperosmolar hyperglycemic state linkedin slideshare. Diabetic ketoacidosis and hyperglycemic hyperosmolar. It most often occurs in type 2 dm, often in the setting of physiologic stress. Less common than other diabetesrelated hyperglycemic syndromes.
Hhs usually develops over a course of days to weeks, unlike diabetic ketoacidosis dka, which can develop in hours to a few days. Diabetic hyperosmolar syndrome symptoms and causes mayo. Hyperglycemic hyperosmolar syndrome hhs is an uncommon form of a diabetic crisis that can occur in dogs and cats that has the following characteristics. Hhns is typically observed in elderly patients with noninsulindependent diabetes. Diabetic hyperosmolar syndrome diagnosis and treatment. Too much glucose in your blood also called hyperglycemia or high blood sugar can cause many problems. This syndrome is characterised by severe hyperglycaemia, a marked increase in serum osmolality, and clinical evidence of dehydration without significant accumulation of ketoacids. Because people with type 2 diabetes produce some insulin, ketoacidosis does not usually develop even when type 2 diabetes is untreated for a long time. Treatment is aggressive rehydration, insulin therapy, electrolyte replacement.
Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Extreme dehydration eventually leads to confusion and lack of ability to even get a drink or make it to the toilet. 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. How is glucose affected by hyperosmolar hyperglycemic state. Dec 01, 2017 hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar. Dec 01, 2000 neonatal camelids can develop hyperglycemia, hypernatremia, and hyperosmolarity in response to a combination of stress and inadequate water intake. Diabetic ketoacidosis and hyperosmolar hyperglycemic state. Diabetic hyperosmolar syndrome is a medical emergency that you wont have time to prepare for. Hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. 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. Oct 10, 2014 the hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis. If you have symptoms of high blood sugar, such as extreme thirst and excessive urination, for a few days, check your blood sugar level and call your doctor for advice.
The hyperglycaemic hyperosmolar state hhs is a medical emergency. Diabetic hyperglycemic hyperosmolar syndrome hhs is a complication of type 2 diabetes. The exact incidence of hhs is not known, but it is estimated to account for 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. An acute decompensated state in which patients manifest a change in mental status in the setting of hyperglycemia, hyperosmolarity and severe volume depletion. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose. If you experience any of the following symptoms of the syndrome, seek emergency medical care immediately. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Diabetic hyperosmolar syndrome symptoms and causes. Hyperglycemic hyperosmolar syndrome hhs is a potentially life threatening condition involving extremely high blood sugar glucose levels when your blood sugar gets too high, the kidneys try. How does hyperosmolar hyperglycemic syndrome occur.
The management of the hyperosmolar hyperglycaemic state hhs. 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 syndrome or diabetic hyperosmolar syndrome is a medical emergency caused by a very high blood glucose level the prefix hyper means high, and osmolarity is a measure of the concentration of active particles in a solution, so the name of the syndrome simply refers to the high concentration of glucose in the blood. Hhs is a metabolic emergency and is associated with a high mortality. Hyperosmolar syndrome in a patient with uncontrolled diabetes. Patients with this syndrome present with hyperglycemia. Hyperosmolar syndrome in a patient with uncontrolled diabetes mellitus haralampos j. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome hhns. Hyperosmolar hyperglycemic state hhs endocrine and. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are two of the. Mar 06, 2012 introduction hyperosmolar hyperglycemic state hhs and diabetic ketoacidosis dka represent two distinct metabolic derangements manifested by insulin deficiency and severe hyperglycemia dka is defined as the presence of all three of the following. Hyperosmolar hyperglycemic state american family physician.
Hyperosmolar hyperglycemic syndrome hhs can have lifethreatening symptoms. Hyperglycemic hyperosmolar syndrome in children diabetes. What are the symptoms of hyperosmolar hyperglycemic syndrome. Management of hyperglycemic hyperosmolar syndrome request pdf. However, although treatment of diabetic ketoacidosis dka in children is familiar. Elisaf, md, frsh c nonketotic hyperglycemic hyperosmolar syndrome hhs is found mostly in type 2 diabetic patients with marked hyperglycemia. Hhs is different from diabetic ketoacidosis dka and treatment requires a different approach. Unlike the other common diabetes emergency, diabetic ketoacidosis dka, guidelines on the management of the hyperglycaemic hyperosmolar state hhs in adults are uncommon. Hyperosmolarity dehydration severe clinical not always ketotic or low levels more common in cats than dogs severe hyperglycemia 600 mgdl 33 mmoll hyperosmolarity 350 mosmkg dehydration lack of ketones. Oct 17, 2016 hyperglycemic hyperosmolar syndrome by. When you have hhs, you are also hyperglycemic meaning the levels of glucose in the blood are too high.
Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. Diabetic ketoacidosis and hyperosmolar hyperglycemic. The hyperglycemic hyperosmolar state hhs is a lifethreatening. Hyperosmolar hyperglycemic syndrome in the elderly diabetic. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing. However, with hyperosmolar hyperglycemic state, the blood glucose levels can become extremely high even exceeding 1,000 milligrams per deciliter mgdl, or 55. Like diabetic ketoacidosis dka, hyperglycemic hyperosmolar syndrome hhs is a deadly and avoidable complication that is due to not having enough insulin for the present condition. Diabetic hyperosmolar syndrome disease reference guide. Hyperglycemic hyperosmolar nonketotic syndrome springerlink. Causes are uti, pneumonia, sepsis, any acute illness, newly diagnosed type 2 diabetes. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. Altered mental status can present as focal neurologic defects or global encephalopathy.
958 474 1345 980 1598 346 1554 1474 71 596 335 960 559 517 218 286 1497 735 1539 28 1011 1228 1214 1225 685 1079 703 1476 523 668 317 490 602 99 961 939 186 1125