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