Mar 31, 2017 diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are diabetic emergencies that cause high morbidity and mortality. Research design and methods we analyzed admissions data listing. Hyperglycemic crises in adult patients with diabetes. Treatment of diabetic ketoacidosis dkahyperglycemic. 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 pdf management of hyperglycemic crises diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious and lifethreatening hyperglycemic emergencies in. Diabetic ketoacidosis, hyperglycemic hyperosmolar state, and. Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state. Dka without a preceding febrile illness or gastroenteritis in a patient with known diabetes is almost always the result of psychosocial problems and failure to appropriately administer insulin. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. The mortality rate in patients with diabetic ketoacidosis dka is hyperosmolar hyperglycemic state hhs still remains high. Diabetic ketoacidosis dka, hyperglycaemic hyperosmolar state hhs and hypoglycaemia are serious complications of diabetes mellitus that require prompt recognition, diagnosis and treatment. Because the approach to the diagnosis and treatment of. Chapter 82 diabetic ketoacidosis, hyperglycemic hyperosmolar state, and alcoholic ketoacidosis gbemisola a.
We investigated hospital outcomes in patients with isolated or combined hyperglycemic crises. They are potentially lifethreatening and require swift recognition and treatment. Hyperosmolar hyperglycemic nonketotic syndrome vs dka. Kitabchi and others published hyperglycemic crises. Diabetic ketoacidosis dka, hyperglycaemic hyperosmolar state hhs and hypoglycaemia are serious complications of diabetes mellitus that. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in.
Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs potentially are fatal but largely preventable acute metabolic conditions of uncontrolled diabetes, the incidence of which. However, the man was not experiencing diabetic ketoacidosis dka. The most common infections that precipitate hyperosmolar hyperglycaemic state are pneumonia and utis. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can. Dec 01, 2017 hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. The discovery of insulin in 1921 changed the life expectancy of patients with diabetes. Hyperosmolar hyperglycaemic state aetiology bmj best practice. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. In addition to the precipitating factors noted above for dka, hhs also has. Ketoacidosis and hyperosmolar hyperglycemia are the two most serious acute metabolic complications of diabetes, even if managed properly. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. Hyperosmolar hyperglycemic state hhs endocrine and.
Like dka, hhs is characterized by very high blood glucose levels, but unlike in dka, people with hhs do not generally have ketones in their blood or urine. Oct 31, 2017 hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus. Ketoacidosis and the hyperglycemic hyperosmolar state adam bursua, pharm. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs cause major morbidity and significant mortality in patients with diabetes mellitus. Cohen diabetic ketoacidosis dka, hyperglycemic hyperosmolar state hhs, and alcoholic ketoacidosis aka are disease entities that are commonly characterized by severe fluid, electrolyte, and acidbase derangements, often prompting evaluation and. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Describe the epidemiology of diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs differentiate between dka and hhs list factors that may precipitate dka and hhs identify the metabolic derangements observed in dka and hhs describe the treatment of dka and hhs as it relates to their pathophysiology. Historically,bothdka and hhs were initially described as one entity but subsequently recognized as separate conditions. Table 1 outlines the diagnostic criteria for dka and hhs. Hyperglycemic emergencies in adults diabetes guidelines. The epidemiology and the factors responsible for the metabolic abnormalities of dka and.
Diabetic ketoacidosis and hyperglycemic hyperosmolar. Hyperosmolar hyperglycemic state american family physician. Pdf diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the two most serious acute metabolic complications of. In both syndromes, there is insufficient insulin levels to transport. Pdf hyperglycemic crises in adult patients with diabetes. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are acute and potentially lifethreatening complications of diabetes. Hyperosmolar hyperglycemic state how to manage your. Jul 31, 2011 a lecture on the recognition, pathogenesis, and management of diabetic ketoacidosis and the hyperosmolar hyperglycemic state.
Hospital management of diabetes awallia and jj seley, section editors treatment of diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs. May 17, 2018 diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. They each represent an extreme in the hyperglycemic spectrum. Hyperosmolar hyperglycaemic state hhs is characterised by extreme elevations in serum glucose concentrations and hyperosmolality without significant ketosis. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are hyperglycemic emergencies that continue to account for increased burden of hospitalizationsinboththeusa1anduk2.
Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a consequence of the underlying precipitating causes rather than a result of the metabolic. Uncovering the precipitating event is critical to management, as morbidity and mortality are related more to the trigger than the dkahhs itself. Treatment of diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs. Dka is responsible for more than 500,000 hospital days per year 1,2 at an estimated annual direct medical expense and indirect cost of 2. Overview of the diabetic ketoacidosis dka hyperglycemic. Introduction diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs, also known as hyperosmotic hyperglycemic nonketotic state hhnk are two of the most serious acute complications of diabetes. Largescale studies to determine optimal management of dka and hhs are lacking. Hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus. The implications of concomitant acidosis and hyperosmolality are not well known. Start studying diabetic ketoacidosis and hyperosmolar hyperglycemic state. Diabetic ketoacidosis and hyperosmolar crisis in adults. The criteria for hyperglycemic hyperosmolar state hhs include. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. Diabetic ketoacidosis dka, and hyperglycemic hyperosmolar state hhs.
Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. Hyperglycemic emergencies diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are common presentations in the ed that require swift, specialized management strategies. 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. In randomized controlled trials, the incidence of dka associated withsglt2inhibitorsislow. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are biochemically different conditions that require different approaches to treatment. Hyperglycemic crises in adult patients with diabetes diabetes care. 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 emergencies. Clinical outcomes in patients with isolated or combined. Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the two most serious acute metabolic complications of diabetes. Diabetic ketoacidosis and hyperglycemic hyperosmolar state risk factors for dka in patients with known diabetes include insulin omission, poor metabolic control, previous episodes of dka, gastroenteritis with persistent vomiting and inability to maintain hydration, psychiatric including eating disorders, challenging. Diabetic ketoacidosis and hyperosmolar hyperglycemic state. Diabetic ketoacidosis and hyperosmolar hyperglycemic state should be sus pected in.
Hyperosmolar hyperglycaemic state investigations bmj. Diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs are potentially fatal hyperglycemic crises that occur as acute complications of uncontrolled diabetes mellitus. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed. Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. Overview of the diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs episode of care 1. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious and lifethreatening hyperglycemic. These disorders can occur in both type 1 and type 2 diabetes. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the two most serious hyperglycemic emergencies in patients with diabetes. Diabetic ketoacidosis, hyperglycemic hyperosmolar state. It is a consequence of a relative or an absolute insulin deficiency in combination with an excess of counterregulatory hormones primarily glucagon and catecholamines, but also cortisol and growth hormone. Although they have important differences, they both occur because of lack of insulin effect and can be considered two manifestations of the same underlying mechanism. Objectives describe the epidemiology of diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs differentiate between dka and hhs.
Diabetic ketoacidosis dka and hyperosmolar hyperglycaemic state hhs are acute severe metabolic complications of uncontrolled diabetes mellitus. Dka or hhs are inadequate insulin therapy and infection true. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs, also known as hyperosmotic hyperglycemic nonketotic state. They often occur in different age groups, and there is a need for coordinated care from the. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs, also known as hyperosmotic hyperglycemic nonketotic state hhnk are two of the most serious acute complications of diabetes. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs find, read and cite all the. It develops slower than dka, typically in the course of several days, but has a. Objective many patients with hyperglycemic crises present with combined features of diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs. Cohen diabetic ketoacidosis dka, hyperglycemic hyperosmolar state hhs, and alcoholic ketoacidosis aka are disease entities that are commonly characterized by severe fluid, electrolyte, and acidbase derangements, often prompting evaluation and management in an.
Hyperosmolar hyperglycemic state, diabetic hhs vs dka. 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. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious and lifethreatening hyperglycemic emergencies in patients with diabetes. These metabolic derangements result from relative insulin deficiency and increased concentration of counterregulatory hormones catecholamines, glucagon, cortisol, and growth hormone. While they may each be seen in pure form, features of the two disorders may also coexist. Diabetic ketoacidosis and the hyperglycemic hyperosmolar state are potentially fatal hy perglycemic crises that occur as acute complications of uncontrolled diabetes mellitus. Use of the va and stanford namelogos is only to indicate my academic. 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%. Hhs are the two most serious acute metabolic complications of diabetes.
Novel advances in the management of hyperglycemic crises uk versus usa ketan k. This article is published with open access at abstract. Although dka and hhs are often discussed as separate entities, they represent points along a spectrum of hyperglycemic emergencies due to poorly controlled diabetes. Jul 07, 2016 chapter 82 diabetic ketoacidosis, hyperglycemic hyperosmolar state, and alcoholic ketoacidosis gbemisola a.
Diagnosis and treatment of diabetic ketoacidosis and the. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults. Hyperosmolar hyperglycemic state hhs hhs and dka are of two of the most serious complications form diabetes hospital admissions for hhs are lower than the rate for dka and accounts for less than 1 percent of all primary diabetic admissions mortality rate for patients with hhs is between 10 and 20 percent, which is approximately 10 times higher than that for dka. Diabetic ketoacidosis dka and hyperosmolar hyperglycaemic state hhs remain among the most commonly encountered metabolic emergencies the diagnosis of dka requires all three components to be present hyperglycaemia or a history of diabetes d, raised plasma ketone concentration k and low ph or low bicarbonate a. Instead, he had a condition called hyperosmolar hyperglycemic state, or hhs. Thirty years of personal experience in hyperglycemic crises.
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