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. Hyperglycemic hyperosmolar nonketotic syndrome medind. Clinical and metabolic characteristics of hyperosmolar. Hyperosmolar hyperglycemic state and diabetic ketoacidosis may represent opposite ends of the spectrum of decompensated diabetes that differ in the time of onset, the degree of severity of ketosis. Arieff and carrolls diagnostic criteria included a blood glucose level. Hyperosmolar nonketotic coma is a serious disorder reported to have a mor tality varying between 20 and 7 0 %. Twelve cases of diabetic hyperosmolar coma without ketosis are described in ten patients. The hallmark of hhns is profound dehydration, marked hyperglycemia, and often some degree of neurologic impairment with mild or no ketosis 1. Get a printable copy pdf file of the complete article 798k.
Typically, the patient, a middleaged or old person with diabetes mellitus of recent onset or without previous history of the disease, lapses into stupor and unconsciousness after manifesting prodromal neurological symptoms, such as. 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. This syndrome is characterised by severe hyperglycaemia, a marked increase in serum osmolality, and clinical evidence of dehydration without significant accumulation of ketoacids. Management of hyperosmolar hyperglycaemic state in adults. Clinical and metabolic data of twenty patients with hyperosmolar nonketotic coma hnc and ten patients in ketoacidosis da are compared. Diabetes increases your risk for many serious health problems. A diagnosis of hhs is made by the medical team based on the. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of. Hyperosmolar hyperglycemic state diabetes care american. Nonketotic diabetic coma has emerged as a distinct syndrome mediated by the hyperosmolarity of the blood.
Glycerol and hyperosmolar nonketotic coma pdf free download. With the correct treatment and recommended lifestyle changes, many people with diabetes are able to prevent or delay the onset of complications. 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. Hhs is characterized by severe hyperglycemia, profound dehydration, and is. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis.
The management of the hyperosmolar hyperglycaemic state hhs. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. Hyperglycemic hyperosmolar nonketotic syndrome researchgate. The treatment for nonketotic hyperglycinemia is based on. Seven of these were complicated by other illnesses. 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.
Limitations of various guidelines include implementation in settings with an infrastructure different from that specified in the guidelines of. The emergencies of diabetic ketoacidosis and a nonketotic hyperosmolar state can occur with both type 1 and type 2 diabetes. Hyperosmolar hyperglycaemic state symptoms, diagnosis. The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of. The hyperosmolarity in this syndrome is due to either gross hyperglycemia or. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Hyperosmolar hyperglycemic nonketotic syndrome sciencedirect.
Hyperglycemia hyperosmolar non ketotic coma ppt xpowerpoint. Diabetic ketoacidosisv hyperglycemic hyperosmolar nonketotic syndrome hhnk cause. 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. Treatment of hyperglycaemic hyperosmolar nonketotic syndrome. Hyperosmolar hyperglycemic nonketotic syndrome the american. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome hhns. Especially, there are limited reportsof the high intensity on t1weighted images and a low intensity on t2weighted images in bothputamina in nonketotic hyperglycemic hemichorea. Hyperosmolar hyperglycemic state hhs endocrine and. Evaluation at presentation revealed profound dehydration, lactic acidosis, and azotemia. The purposes of this study were to characterize the hyperglycemic, hyperosmolar syndrome hhs, also known as nonketotic hyperosmolar diabetes, in cats. Hyperosmolar diabetic coma ketotic and nonketotic jama.
Hyperglycemic hyperosmolar nonketotic syndrome hhns is one of the most severe acute complications of 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. Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine. 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. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Neurologic and respiratory signs occurred frequently. Changing the name to hyperosmolar hyperglycaemic state hhs allows for the fact that some people with severely raised blood glucose may.
Hyperosmolar hyperglycemic state linkedin slideshare. Client concerns included polydipsia, polyuria, and lethargy. The first step of treatment involves careful monitoring. The sudden increased level of sugar result in hypotension and tachycardia, complicating into coma and death. Diabetic ketoacidosis occurs more commonly with type 1. Patients were managed with relatively small amounts of fluid, and the type of. Careful monitoring of glucose levels and ensuring adequate hydration in patients at risk of hhns, including those receiving medications that interfere with the. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. These labels include hyperosmolar nonketotic coma, hyperosmolar hyperglycemic nonketotic coma, and hyperglycemic hyperosmolar nonketotic syndrome hackel, 2014. Hyperosmolar hyperglycemic nonketotic syndrome, or hhns, is a serious condition most frequently seen in older persons. Colorado hyperosmolar nonketotic coma hnc, reportedly first described as a clinical entity by frerichs 1 more than 80 years ago, has had a resurgence of interest since sament and schwartz 2 redescribed it in 1957. Hyperglycemic, hyperosmolar syndrome was seen in older cats that were often long. Department of pediatrics, advanced pediatrics center, post graduate. Hyperosmolar nonketotic crises occur chiefly in mild, maturityonset diabetics, yet present a medical emergency carrying a high mortality.
Hyperglycemic, hyperosmolar syndrome in feline diabetics. Also referred to as hyperosmolar hyperglycemic state hhs, nonketotic hyperosmolar coma nkhoc is an acute complication of diabetes meillitus type 2. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Hhs has been known by several other names in the past. 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. Symptoms include signs of dehydration, weakness, legs cramps, trouble seeing, and an altered level of. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. In a series of 22 patients with the hyperosmolar hyperglycemic nonketotic syndrome managed during a fiveyear period in a community hospital setting. Hyperglycemic, hyperosmolar, nonketotic coma in a ketosis. Hospitalizations for hyperosmolar hyperglycemic nonketotic syndrome as firstlisted diagnosis in adults with diabetes, united states.
Hyperosmolar hyperglycemic state on the web most recent articles. Hyperosmolar hyperglycemic state ada pdf hyperosmolar hyperglycemic nonketotic syndrome, or hhns, is a serious condition most frequently seen in older persons. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. In both syndromes, there is insufficient insulin levels to transport. Hyperosmolar hyperglycemic nonketotic syndrome hhns. Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic hyperosmolar coma nkhhc. 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. In this study, hyperosmolarity was not related to coma or to final outcome of treatment.
How do i view different file formats pdf, doc, ppt, mpeg on this site. Hyperglycaemic hyperosmolar state hhs is a medical emergency, which differs from diabetic ketoacidosis dka and requires a different approach. Hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. Hyperglycemic hyperosmolar state hhs is an acute complication associated with diabetes mellitus. This may in part be due to a lack of awareness of the clinical presentation, and of the principles of treatment. Diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs appear as 2 extremes in the spectrum of diabetic decompensation. Common precipitating factors in hnc included infection, dehydration and administration of diabetogenic drugs. Hyperosmolarity without nonketotic hyperglycemic hyperosmolar coma due to type 2 diabetes mellitus. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva ada american diabetes association. The management of the hyperosmolar hyperglycaemic state. Hhns is an emergency caused by very high blood sugar, often over 600 mgdl. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed.
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