Management of the hyperosmolar hyperglycemic syndrome. Hyperosmolar hyperglycaemic state linkedin slideshare. Excessive synthesis of ketone bodies from free fatty acids. It can be fatal or lead to permanent neurologic damage. 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. Treatment of hyperglycaemic hyperosmolar nonketotic. Severe hyperglycemia due to insufficient insulin resulting in plasma hyperosmolality and excessive water loss. Diabetic ketoacidosis dka and hyperosmolar hyperglycaemic state hhs are acute severe metabolic complications of uncontrolled diabetes mellitus. V2 approved by policy and guideline committee on 29 november 2019 trust ref. 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.
Souto 1,olindamarques 1 1endocrinologydepartment,hospitalbraga,portugal. Diabetic ketoacidosis and hyperosmolar crisis in adults. 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 250 mgdl 14 mmoll, usually much higher plasma glucose 600 mgdl 33 mmoll arterial ph 7. Hyperosmolar hyperglycaemic state hhs in adults uhl guideline. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis.
Hhnk syndrome is characterized by extremely high blood glucose levels. Results for hyperosmolar hyperglycemic state 1 10 of 15 sorted by relevance date. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. Hyperosmolar hyperglycaemic state an intensivists perspective presenter. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. Hyperglycaemic hyperosmolar nonketotic coma is a short term complication requiring immediate treatment by a healthcare professional. Symptoms of honk before loss of consciousness and coma takes place. Hyperosmolar hyperglycaemic state acute medicine wiley online. Hyperosmolar hyperglycaemic state hhs occuring in type 2 diabetes. Hyperosmolar nonketotic coma hyperglycemic hyperosmolar.
Management of the hyperosmolar hyperglycaemic state hhs. Hhs can occur in people with type 1 or type 2 diabetes, but is more common in people with type 2 diabetes. 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 hyperglycaemic state hhs occurs in people with type 2 diabetes who experience very high blood glucose levels often over 40mmoll. Dka is caused by absolute insulin deficiency and is usually seen in the context of type 1 diabetes. Hyperosmolar hyperglycemic state hhs is a serious medical condition that develops if your blood sugar levels get very high. Emergency management of hyperglycaemia in primary care. Hyperosmolar hyperglycemic state hhs by jorge mejia. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes. While they may each be seen in pure form, features of the two disorders may also coexist. Quality standards for diabetes care toolkit implementation advice uncontrolled diabetes should be recognised and appropriate management and followup arranged by a specialist diabetes team. 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.
Hyperosmolar hyperglycemic nonketotic syndrome hhns. If the address matches an existing account you will receive an email with instructions to reset your password. Hyperosmolar hyperglycemic state linkedin slideshare. D anaesthesiologist and intensive care practitioner swagat slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Management of hyperosmolar hyperglycaemic state in adults with. Unlike the other common diabetes emergency, diabetic ketoacidosis dka, guidelines on the management of the hyperglycaemic hyperosmolar state hhs in adults are uncommon and often there is little to differentiate them from the management of dka. Infection is the most common cause, but many other conditions can cause altered mentation, dehydration, or both. Hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Hyperglycaemic, hyperosmolar nonketotic hhnk syndrome is an uncommon complication of untreated canine diabetes.
The management of the hyperosmolar hyperglycaemic state hhs. Hyperosmolar hyperglycaemic state hhs is a diabetic emergency that. State of hyperosmolality with low or no ketone bodies. This syndrome is characterised by severe hyperglycaemia, a marked increase in serum osmolality, and clinical evidence of dehydration without significant accumulation of ketoacids. Summary hyperosmolar hyperglycaemic state hhs typically occurs in patients with type 2 diabetes, but can also occur in type 1 diabetes.
Hyperosmolar hyperglycemic state inpatient care what. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. It is an emergency and the prognosis for recovery is poor. Hyperglycaemic hyperosmolar nonketotic coma is a dangerous condition brought on by very high blood glucose levels in type 2 diabetes above 33 mmoll. Abstract hyperglycaemic hyperosmolar state hhs is a medical. Hyperglycaemic, hyperosmolar, nonketotic hhnk syndrome. Click export csv or ris to download the entire page or use the checkboxes to select a subset of records to download. However, hhs is different and treatment requires a different approach. Kussmaul respiration, acetone breath, nausea, vomiting, abdominal pain. Your body gets rid of the extra sugar through your urine. Hyperglycaemic hyperosmolar state british journal of. Hyperosmolar hyperglycaemic state diagnosis history. In the majority of cases, people with uncontrolled diabetes should be managed in hospital by specialist care.
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