Hyperosmolar hyperglycemic nonketotic syndrome sciencedirect. 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. This syndrome is characterised by severe hyperglycaemia, a marked increase in serum osmolality, and clinical evidence of dehydration without significant accumulation of ketoacids. The management of hyperosmolar hyperglycaemic state hhs in adults with diabetes. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33.
Diabetic emergencies ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Patients admitted to icu via ed with hhs hyperosmolar hyperglycemic. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. The name changed from honk hyperosmolar non ketotic coma to hyperosmolar hyperglycaemic state to allow for the fact that some patients may be extremely ill but not comatose and may also be mildly ketotic and acidotic. Hyperosmolar nonketotic diabetic syndrome following treatment of human immunodeficiency virus infec tion with didanosine. Longterm steroid use19 and gastroenteritis20 are common causes of hyperosmolar hyper glycemic state in children.
It develops slower than dka, typically in the course of several days, but has a. Diabetic ketoacidosis and hyperosmolar hyperglycemic. The management of the hyperosmolar hyperglycaemic state hhs. It can occur as a complication of borderline and unrecognized diabetes mellitus, in pancreatic disorders that interfere with the production of insulin, as a complication of extensive burns, and in conditions marked by an excess of steroids, as. Treatment begins with intensive monitoring of the patient and laboratory values, especially glucose. This complication may arise in persons having any type of the diabetes, type 1 diabetes as well as type 2 diabetes.
This state is also known by some other terms like hyperosmolar hyperglycemic nonketotic coma hhnkc or hyperosmotic nonketoic acidosis honk. Feb 26, 2019 nonketotic hyperosmolar coma is a life threatening metabolic derangement that can develop in people with diabetes mellitus, usually due to illness, infection or failure to monitor blood glucose. 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. Hyperglycemic hyperosmolar nonketotic syndrome medind.
Hyperosmolar hyperglycemic nonketotic syndrome hhns. Hyperglycemic hyperosmolar nonketotic syndrome hhns is one of the most severe acute complications of diabetes. The hallmark of hhns is profound dehydration, marked hyperglycemia, and often some degree of neurologic impairment with mild or no ketosis 1. Joint british diabetes societies jbds 2012 aug pdf, summary of report can be found in diabet med 2015 jun. Definitions dka consists of the biochemical triad of hyperglycemia, ketonemia and metabolic high anion gap acidosis the term hyperglycemic hyperosmolar nonketotic coma has been replaced with the term hyperglycemic hyperosmolar state hhs 1the hyperglycemic hyperosmolar state may consist of moderate to variable degrees of. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped.
The major clinical features are severe hyperglycemia blood glucose greater than 600 mg per 100 ml, absence of ketosis or ketoacidosis, profound dehydration. Symptoms of honk before loss of consciousness and coma takes place. Seven died, but in five death was probably not due to the hyperosmolar state. The condition most commonly occurs in people with type 2 diabetes. Hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. People with diabetes showed the risk of the development of acute metabolic complications such as diabetic ketoacidosis, hyperglycaemic hyperosmolar nonketotic coma, and hypoglycaemia 7. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Dec 01, 2017 hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. Buildup of ketones in the body ketoacidosis may also occur. Hyperosmolar nonketotic hyperglycemic coma, what is it. In most medical contexts, the term diabetic coma refers to the diagnostical dilemma posed when a physician is confronted with an unconscious patient about whom nothing is known except that.
Diabetic ketoacidosis and hyperglycemic hyperosmolar. Abstract a 24yearold juvenile diabetic with many episodes of diabetic ketoacidosis presented with hyperglycemic, hyperosmolar, nonketotic coma that progressed rapidly to death despite vigorous conventional therapy with hypotonic fluids, insulin, and potassium. A hyperosmolar coma, also known as a hyperosmolar nonketotic coma honk, is a serious complication associated with type 2 diabetes. The name changed from honk hyperosmolar non ketotic coma to hyperosmolar. Persistent hyperglycemia causes osmotic diuresis, which results in the fluid and electrolyte imbalances.
Treatment of hyperglycaemic hyperosmolar nonketotic syndrome. It can occur as a complication of borderline and unrecognized diabetes mellitus, in pancreatic disorders that interfere with the production of insulin, as a complication of extensive burns, and in conditions marked by an. The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia. Hyperosmolar nonketotic coma definition of hyperosmolar. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. May 29, 2019 diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes.
Hyperglycemic hyperosmolar nonketotic syndrome with. Diabetic coma hyperosmolar hyperglycemic state symptoms. Common precipitating factors in hnc included infection, dehydration and administration of diabetogenic drugs. Hyperosmolar hyperglycemic state diabetes care american. Hyperosmolar hyperglycemic state winchester hospital. Hyperglycemic hyperosmolar nonketotic syndrome hhns is a condition characterized by the presence of hyperglycemia, hyperosmolarity, and dehydration. Mar 06, 2012 definitions dka consists of the biochemical triad of hyperglycemia, ketonemia and metabolic high anion gap acidosis the term hyperglycemic hyperosmolar nonketotic coma has been replaced with the term hyperglycemic hyperosmolar state hhs 1the hyperglycemic hyperosmolar state may consist of moderate to variable degrees of. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes. Oct 10, 2014 the hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious and lifethreatening hyperglycemic emergencies in diabetes. Hyperglycaemic hyperosmolar nonketotic coma is a short term complication requiring immediate treatment by a healthcare professional. Rhabdomyolysis is an unusual but underestimated complication of hhns 2.
There is enough production of insulin to reduce ketosis but not to control hyperglycemia. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Glycerol and hyperosmolar nonketotic coma pdf free download. Hyperosmolar nonketotic coma is a serious disorder reported to have a mor tality varying between 20 and 7 0 %. Resulting from the development of hyperosmolarity, or extremely high blood glucose levels, there are a number of risk factors associated with the development of this condition. Twelve cases of diabetic hyperosmolar coma without ketosis are described in ten patients. Clinical and metabolic data of twenty patients with hyperosmolar nonketotic coma hnc and ten patients in ketoacidosis da are compared. Clinical and metabolic characteristics of hyperosmolar. Hyperosmolar hyperglycemic state linkedin slideshare.
Hyperosmolar nonketotic coma in the elderly diabetic sciencedirect. 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 nonketotic state hns is a dangerous form of diabetic coma. In one study18 of an urban population presenting with hyperos molar hyperglycemic state, the three leading causes were poor compliance with medica tion, ethanol ingestion, and cocaine use. Dka is more common in young people with type 1 diabetes and hhs in adult and elderly patients with type 2 diabetes. Hyperosmolar hyperglycemic state american family physician. 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. Diabetic hyperosmolar syndrome symptoms and causes. Diabetic hyperglycemic hyperosmolar syndrome hhs is a complication of type 2 diabetes. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. Hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus.
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. As glucose builds up in your blood, your body tries to get rid of it through your urine. Seven of these were complicated by other illnesses. 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 hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Hyperosmolar hyperglycemic state, diabetic hhs vs dka. But it is unusual and is often mild compared with diabetic ketoacidosis. The hyperosmoiar hyperglycemic nonketotic syndrome, also referred to as hyperglycemic hyperosmolar nonketotic coma, is a weilrec ognized clinical entity first. It involves extremely high blood sugar glucose level without the presence of ketones.
Hyperosmolar nonketotic coma usually type 2 in which an extremely high blood sugar level and dehydration alone are sufficient to cause unconsciousness. 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%. Hyperglycaemic hyperosmolar nonketotic coma is a dangerous condition brought on by very high blood glucose levels in type 2 diabetes above 33 mmoll. Pdf hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing. Hyperosmolar nonketotic state diabetes wiki fandom. Physical findings include profound dehydration and neurologic symptoms ranging from lethargy to coma. 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. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Features of the 2 disorders with ketoacidosis and hyperosmolality may coexist. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness.
In children and adolescents, hyperosmolar hyperglycemic state is often present when type 2 diabetes is diagnosed. In the acute neurosurgical setting, nonketotic hyperosmolar hyperglycemic coma nhc is thought to be caused by cerebral dehydration therapy and administration of steroids, glycerol, or mannitol. Diabetic hyperosmolar syndrome symptoms and causes mayo. An assessment of insulin action in hyperosmolar hyperglycemic nonketotic diabetic patients. Webmd tells you the symptoms to look out for and how its treated. Hyperosmolarity must also be considered as a factor in the coma associated with ordinary diabetic ketosis. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Hyperosmolar hyperglycemic state hhs endocrine and. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm.
Hyperosmolar hyperglycaemic state symptoms, diagnosis. Oct 31, 2017 hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. 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 33. A diabetic coma could happen when your blood sugar gets too high 600 milligrams per deciliter mgdl or more causing you to become very dehydrated it usually affects people with type 2. What are the symptoms of hyperosmolar hyperglycemic. Hyperosmolar nonketotic state hhs or coma happens in people with diabetes. Hyperglycemic, hyperosmolar, nonketotic coma in a ketosis. Traumatic brain injuries are the most frequent cause. Diabetic coma occurs when blood sugar gets too high and the body becomes severely dehydrated. It can also happen if the diabetes treatment plan is not followed.
Definition also referred to as hyperosmolar hyperglycemic state hhs, nonketotic hyperosmolar coma nkhoc is an acute complication of diabetes meillitus type 2. The hyperosmolarity in this syndrome is due to either gross hyperglycemia or. Apr 12, 2019 hyperglycemic hyperosmolar nonketotic syndrome hhns is a condition characterized by the presence of hyperglycemia, hyperosmolarity, and dehydration. Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a consequence of the underlying precipitating causes rather. Treatment of diabetic coma with continuous lowdose infusion of insulin. Now it is being diagnosed with increasing frequency in.