Hyperosmolar diabetic coma ketotic and nonketotic jama. Client concerns included polydipsia, polyuria, and lethargy. Hyperosmolar nonketotic coma is a serious disorder reported to have a mor tality varying between 20 and 7 0 %. Hhns is an emergency caused by very high blood sugar, often over 600 mgdl. Hyperglycemic, hyperosmolar syndrome in feline diabetics. Hhs has been known by several other names in the past. Find powerpoint presentations and slides using the power of, find free presentations research about hyperglycemia hyperosmolar non ketotic coma ppt. The hallmark of hhns is profound dehydration, marked hyperglycemia, and often some degree of neurologic impairment with mild or no ketosis 1. Hyperglycemic hyperosmolar nonketotic syndrome with. The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of. 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. 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.
The hyperosmolarity in this syndrome is due to either gross hyperglycemia or. Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed. 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 nonketotic syndrome hhns is one of the most severe acute complications of diabetes. Hyperosmolarity without nonketotic hyperglycemic hyperosmolar coma due to type 2 diabetes mellitus. Seven of these were complicated by other illnesses. Diagnosis and management of hyperglycemic emergencies. 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. Hyperglycemia hyperosmolar non ketotic coma ppt xpowerpoint. Diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs appear as 2 extremes in the spectrum of diabetic decompensation. Diabetic ketoacidosis and hyperosmolar hyperglycemic. How do i view different file formats pdf, doc, ppt, mpeg on this site.
Common precipitating factors in hnc included infection, dehydration and administration of diabetogenic drugs. Hyperosmolar hyperglycemic state hhs endocrine and. Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic hyperosmolar coma nkhhc. The management of the hyperosmolar hyperglycaemic state. The management of the hyperosmolar hyperglycaemic state hhs. Diabetic ketoacidosisv hyperglycemic hyperosmolar nonketotic syndrome hhnk cause. The sudden increased level of sugar result in hypotension and tachycardia, complicating into coma and death. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently.
Hyperosmolar hyperglycemic state diabetes care american. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Rhabdomyolysis is an unusual but underestimated complication of hhns 2. Evaluation at presentation revealed profound dehydration, lactic acidosis, and azotemia. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. Hyperglycemic, hyperosmolar syndrome was seen in older cats that were often long.
Twelve cases of diabetic hyperosmolar coma without ketosis are described in ten patients. Arieff and carrolls diagnostic criteria included a blood glucose level. Symptoms include signs of dehydration, weakness, legs cramps, trouble seeing, and an altered level of. A diagnosis of hhs is made by the medical team based on the. 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 is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. Treatment of hyperglycaemic hyperosmolar nonketotic syndrome. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with 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. Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine.
These labels include hyperosmolar nonketotic coma, hyperosmolar hyperglycemic nonketotic coma, and hyperglycemic hyperosmolar nonketotic syndrome hackel, 2014. Clinical and metabolic data of twenty patients with hyperosmolar nonketotic coma hnc and ten patients in ketoacidosis da are compared. The first step of treatment involves careful monitoring. Hyperosmolar hyperglycemic nonketotic syndrome sciencedirect. Limitations of various guidelines include implementation in settings with an infrastructure different from that specified in the guidelines of. Hyperglycemic hyperosmolar state hhs is an acute complication associated with diabetes mellitus. Hhs is characterized by severe hyperglycemia, profound dehydration, and is. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva ada american diabetes association. Hyperosmolar hyperglycemic state ada pdf hyperosmolar hyperglycemic nonketotic syndrome, or hhns, is a serious condition most frequently seen in older persons. Department of pediatrics, advanced pediatrics center, post graduate. Hyperosmolar hyperglycemic state on the web most recent articles.
Nonketotic diabetic coma has emerged as a distinct syndrome mediated by the hyperosmolarity of the blood. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. 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 linkedin slideshare. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. 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. Hyperglycemic, hyperosmolar, nonketotic coma in a ketosis. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome hhns.
Changing the name to hyperosmolar hyperglycaemic state hhs allows for the fact that some people with severely raised blood glucose may. In a series of 22 patients with the hyperosmolar hyperglycemic nonketotic syndrome managed during a fiveyear period in a community hospital setting. Hyperosmolar hyperglycemic nonketotic syndrome hhns. Careful monitoring of glucose levels and ensuring adequate hydration in patients at risk of hhns, including those receiving medications that interfere with the. In both syndromes, there is insufficient insulin levels to transport. 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. Management of hyperosmolar hyperglycaemic state in adults. 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. 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. Hyperosmolar hyperglycaemic state symptoms, diagnosis. Hyperglycemic hyperosmolar nonketotic syndrome medind. The purposes of this study were to characterize the hyperglycemic, hyperosmolar syndrome hhs, also known as nonketotic hyperosmolar diabetes, in cats. Get a printable copy pdf file of the complete article 798k. Hyperglycaemic hyperosmolar state hhs is a medical emergency, which differs from diabetic ketoacidosis dka and requires a different approach.
Hyperosmolar hyperglycemic nonketotic syndrome, or hhns, is a serious condition most frequently seen in older persons. Hyperosmolar hyperglycemic nonketotic syndrome the american. Hospitalizations for hyperosmolar hyperglycemic nonketotic syndrome as firstlisted diagnosis in adults with diabetes, united states. View and download powerpoint presentations on hyperglycemia hyperosmolar non ketotic coma ppt. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. Hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. The treatment for nonketotic hyperglycinemia is based on. 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. In this study, hyperosmolarity was not related to coma or to final outcome of treatment. 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. 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.
Also referred to as hyperosmolar hyperglycemic state hhs, nonketotic hyperosmolar coma nkhoc is an acute complication of diabetes meillitus type 2. Diabetic ketoacidosis occurs more commonly with type 1. 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. Diabetes increases your risk for many serious health problems.
106 851 1124 656 1084 1493 808 481 1426 1582 1548 281 1593 91 1118 1093 989 690 579 650 1145 1490 536 578 1028 94 652 824 462 524 139 1466 998