Webmd tells you the symptoms to look out for and how its treated. Hyperosmolar hyperglycemic state hhs endocrine and. 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. Hyperosmolar hyperglycemic state, diabetic hhs vs dka. Hyperglycaemic hyperosmolar nonketotic coma is a short term complication requiring immediate treatment by a. Common precipitating factors in hnc included infection, dehydration and administration of diabetogenic drugs. 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. Twelve cases of diabetic hyperosmolar coma without ketosis are described in ten patients. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. 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.
The nursing care plan for clients with diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome includes provision of information about disease processprognosis, selfcare, and treatment needs, monitoring and assistance of cardiovascular, pulmonary, renal, and central nervous system cns function, avoiding dehydration, and. Seven died, but in five death was probably not due to the hyperosmolar state. Diabetic coma hyperosmolar hyperglycemic state webmd. The goals of treatment are to provide frequent patient monitoring, to treat the underlying cause and to gradually and safely. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. May 29, 2019 diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. What are the symptoms of hyperosmolar hyperglycemic nonketotic syndrome. Hhns is typically observed in elderly patients with noninsulindependent diabetes.
Pdf overview of cerebral edema during correction of. The sudden increased level of sugar result in hypotension and tachycardia, complicating into coma and death. 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. The management of the hyperosmolar hyperglycaemic state hhs. It can also happen if the diabetes treatment plan is not followed.
Get a printable copy pdf file of the complete article 798k. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. 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, also known as hyperosmotic hyperglycemic nonketotic state hhnk are two of the most serious acute complications of diabetes. It develops slower than dka, typically in the course of several days, but has a. Hyperosmolar hyperglycaemic state symptoms, diagnosis and. Hyperosmolar nonketotic coma definition of hyperosmolar.
Hyperglycaemic hyperosmolar nonketotic coma is a short term complication requiring immediate treatment by a healthcare professional. Oct 27, 2012 hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. Nonketotic hyperosmolar coma usually develops more insidiously than diabetic ketoacidosis because the principal symptom is lethargy progressing to obtundation, rather than vomiting and an obvious illness. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is 1 of 2 serious metabolic derangements that occurs in patients with diabetes mellitus dm and can be a lifethreatening emergency. The hyperosmolarity in this syndrome is due to either gross hyperglycemia or. 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%. This syndrome is characterised by severe hyperglycaemia, a marked increase in serum osmolality, and clinical evidence of dehydration without significant accumulation of ketoacids. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. 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. Although critical illness polyneuropathy cip is not included in the textbook differential diagnosis, there is one case report showing an association of cip to hyperosmolar nonketotic coma 2. Hyperosmolar hyperglycemic nonketotic syndrome hhns. Treatment of hyperglycaemic hyperosmolar nonketotic syndrome.
Diabetic hyperglycemic hyperosmolar syndrome hhs is a complication of type 2 diabetes. Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a consequence of the underlying precipitating causes rather. Glycerol and hyperosmolar nonketotic coma pdf free download. It involves extremely high blood sugar glucose level without the presence of ketones. 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. Hyperglycaemic hyperosmolar nonketotic coma is a dangerous condition brought on by very high blood glucose levels in type 2 diabetes above 33 mmoll. Hyperosmolar hyperglycemic state hhs is the nomenclature recommended by the american diabetes association to emphasize the varying alterations in sensorium less than coma that are usually present in humans and that hhs may occur with mild ketosis and acidosis nugent, 2005. Diabetic hyperosmolar syndrome symptoms and causes mayo.
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. They each represent an extreme in the hyperglycemic spectrum. This clinical condition was formerly called nonketotic hyperglycemic coma. Pattavina a 46yrold hypertensive man treated for 1 yr with apresoline 200 mg and propranolo1 240 mg daily, was admitted in deep coma, severely dehydrated, serum glucose 1 mgloo ml without ketonemia, normal serum coz, blood ph 7. 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 diagnosis, and treatment diabetes care 2014. Clinical and metabolic characteristics of hyperosmolar. Extremely high blood sugar levels are accompanied by dehydration due to inadequate fluid intake. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness.
Hyperosmolar nonketotic state hhs or coma happens in people with diabetes. Although a few cases of cerebral edema have been reported in patients with nonketotic hyperosmolar coma nkhc, these are in general not well documented by. Dec 01, 2017 hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. Diabetic coma occurs when blood sugar gets too high and the body becomes severely dehydrated. Hhns is an emergency caused by very high blood sugar, often over 600 mgdl. Hyperosmolar hyperglycemic state winchester hospital.
Find out information about hyperosmolar nonketotic coma. 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 n o n k e t o t i c coma d a v i d e. Hyperosmolar hyperglycemic state american family physician. What are the symptoms of hyperosmolar hyperglycemic. Traumatic brain injuries are the most frequent cause. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing. Seven of these were complicated by other illnesses. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes. Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine. The latter designation is a misnomer, because a mild degree of ketosis often is present, and a true coma is uncommon.
Hyperosmolar nonketotic coma article about hyperosmolar. A complication of propranolol therapy by stephen podolsky and catherine g. The mortality rate of hyperosmolar hyperglycemic state ranges from 10 to 50 percent, higher rate than that of diabetic ketoacidosis 1. Also referred to as hyperosmolar hyperglycemic state hhs, nonketotic hyperosmolar coma nkhoc is an acute complication of diabetes meillitus type 2. Clinical and metabolic data of twenty patients with hyperosmolar nonketotic coma hnc and ten patients in ketoacidosis da are compared. Hyperosmolar hyperglycaemic state symptoms, diagnosis. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs, also called hyperosmotic hyperglycemic nonketotic state hhnk are two of the most serious acute complications of diabetes. A thrombotic stroke or cerebropontine myelinolysis associated with high serum osmolarity and cerebral edema are wellknown complications of hyperosmolar nonketotic coma 1. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome hhns.
Oct 10, 2014 the hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Understanding the presentation of hyperglycemic hyperosmolar. 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. Diabetic ketoacidosis and hyperglycemic hyperosmolar. Changing the name to hyperosmolar hyperglycaemic state hhs allows for the fact that some people with severely raised blood glucose may also be mildly ketotic and acidotic. Understanding the presentation of hyperglycemic hyperosmolar nonketotic syndrome.
130 1033 252 1525 1033 919 1083 1265 754 764 1123 935 330 936 1228 1384 1033 423 464 1019 1074 581 593 1516 565 76 1279 828 695 819 677 1135 1012 9 1019 962 111 824 1240 730 1245 446