What is the difference between diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome

DKA is characterized by ketoacidosis and hyperglycemia, while HHS usually has more severe hyperglycemia but no ketoacidosis (table 1). Each represents an extreme in the spectrum of hyperglycemia. The precipitating factors, clinical features, evaluation, and diagnosis of DKA and HHS in adults will be reviewed here.

How can you tell the difference between DKA and HHS?

DKA usually evolves rapidly. In HHS, there is little or no ketoacidosis and the serum glucose concentration frequently exceeds 1000 mg/dL. HHS usually evolves over a period of several days. Overlap between DKA and HHS occurs in more than one-third of patients.

Why is hyperglycemia more in HHS than DKA?

In addition, DKA patients tend to be younger than HHS patients, and thereby have a higher glomerular filtration rate. Accordingly, DKA patients have a greater ability to excrete glucose in urine and can thereby limit the hyperglycemia.

What is diabetic hyperosmolar syndrome?

Diabetic hyperosmolar (hi-pur-oz-MOE-lur) syndrome is a serious condition caused by extremely high blood sugar levels. The condition most commonly occurs in people with type 2 diabetes. It’s often triggered by illness or infection.

Is hyperglycemia the same as ketoacidosis?

Hyperglycemia can be a serious problem if you don’t treat it, so it’s important to treat as soon as you detect it. If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn’t have enough insulin.

Why are there no ketones in HHS?

Serum ketones are not present because the amounts of insulin present in most patients with type 2 diabetes are adequate to suppress ketogenesis.

What are the most common factors for DKA and HHS What is the main difference in HHS?

Both DKA and HHS are characterized by hyperglycemia and absolute or relative insulinopenia. Clinically, they differ by the severity of dehydration, ketosis, and metabolic acidosis (17). DKA most often occurs in patients with T1D.

How is hyperglycemic hyperosmolar treated?

1. Fluids given through a vein (intravenously) to treat dehydration.
2. Insulin given through a vein (intravenously) to lower your blood sugar levels.
3. Potassium and sometimes sodium phosphate replacement given through a vein (intravenously) to help your cells function correctly.

How is hyperglycemic hyperosmolar nonketotic syndrome treated?

Treatment. Treatment typically involves starting intravenous (IV) fluids (saline solution delivered through a needle into a vein) to rehydrate the body quickly. It also may require IV insulin to bring down blood sugar levels. If you are hospitalized due to HHNS, you may be kept overnight for observation.

Which symptom is associated with hyperosmolar hyperglycemic syndrome?

A serious complication of diabetes mellitus, hyperosmolar hyperglycemic syndrome (HHS) happens when blood sugar levels are very high for a long period of time. Symptoms of HHS can include extreme thirst, frequent urination, changes in your vision and confusion.

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Is HHS and honk the same?

Hperglycemic hyperosmolar state (HHS) previously known as hyperosmolar nonketotic (HONK) coma is a syndrome characterized by extreme elevations in serum glucose concentrations, hyperosmolality and dehydration without significant ketosis (1,2).

Which complication of diabetes can cause hypoglycemia unawareness?

If you are like approximately 40% of people with Type 1 diabetes, you probably have some degree of hypoglycemia unawareness. This is a complication of T1D during which patients experience severe low blood sugars but do not feel them.

Why is Bicarb high in HHS?

The bicarbonate concentration in a patient with HHS is usually normal or mildly reduced. This is because there is minimal ketone formation in the process of HHS, in contrast to DKA, in which bicarbonate levels can be markedly reduced (bicarbonate < 15mEq/L).

What's the difference between hyperglycemia and diabetes?

Hyperglycemia, or high blood glucose, is a symptom that characterizes diabetes. Insufficient insulin production, resistance to the actions of insulin, or both can cause diabetes to develop. When a person eats carbohydrates, the body breaks them down into simple sugars that enter the bloodstream.

What is the most common cause of diabetic ketoacidosis?

DKA is a state of absolute or relative insulin deficiency aggravated by ensuing hyperglycemia, dehydration, and acidosis-producing derangements in intermediary metabolism. The most common causes are underlying infection, disruption of insulin treatment, and new onset of diabetes.

Do Type 2 diabetics get ketoacidosis?

Diabetic ketoacidosis (DKA) is a serious complication of diabetes that can be life-threatening. DKA is most common among people with type 1 diabetes. People with type 2 diabetes can also develop DKA. DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy.

What are the 4 most common leading complications of diabetes?

1. Heart disease. A diabetic has twice a non-diabetic’s likelihood of dying of heart disease, including stroke. …
2. Foot problems. Diabetes reduces circulation. …
3. Kidney disease. Diabetes is the foremost cause of kidney disease. …
4. Eye problems.

Does hyperglycemia cause DKA?

Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus.

What causes Kussmaul breathing?

Causes: Kussmaul breathing is usually caused by high acidity levels in the blood. Cheyne-Stokes breathing is usually related to heart failure, stroke, head injuries, or brain conditions. Pattern: Kussmaul breathing doesn’t alternate between periods of fast and slow breathing.

Why is mortality higher in HHS than DKA?

Mortality in hyperglycemic crisis is primarily due to the underlying precipitating illness and only rarely to the metabolic complications of hyperglycemia or ketoacidosis [1,9]. The prognosis of hyperglycemic crisis is substantially worse at the extremes of age and in the presence of coma and hypotension [9-12].

Can HHS cause seizures?

In more advanced HHS, presentation is more likely to be altered mental status, seizures and/or coma. Patients may also present with an underlying fever, a clue to an underlying infection.

Does HHS cause metabolic acidosis?

A wide anion gap can be observed in patients with HHS, reflecting mild metabolic acidosis. The mild acidosis in HHS is often multifactorial and results, in part, from the accumulation of minimal ketoacids in the absence of effective insulin activity.

How do you treat honk?

Treatment for HONK Treatment for hyperglycaemic hyperosmolar non-ketotic coma will include fluids being given to the patient and insulin administered intravenously.

Which of the following would be the most appropriate treatment for a patient with hyperglycemic hyperosmolar nonketotic acidosis?

We prefer to administer 0.9% NaCl until the vital signs have stabilised and then substitute 0.45% NaCl. 10 to 15 units of regular human insulin should be injected as a bolus, followed by a continuous infusion of approximately 0.1 U/kg/h.

What is hyperglycemia without ketosis?

Hyperglycemic hyperosmolarity is part of a clinical spectrum of severe hyperglycemic disorders ranging from pure hyperglycemic hyperosmolarity without ketosis to diabetic ketoacidosis, with significant overlap in the middle.

Does HHS need ICU?

All patients diagnosed with HHS require hospitalization; virtually all need admission to a monitored unit managed by medicine, pediatrics, or the intensive care unit (ICU) for close monitoring. When available, an endocrinologist should direct the care of these patients.

How does insulin correct hyperglycemia?

Adjustments to your insulin program or a supplement of short-acting insulin can help control hyperglycemia. A supplement is an extra dose of insulin used to help temporarily correct a high blood sugar level. Ask your doctor how often you need an insulin supplement if you have high blood sugar.

What's the opposite of DKA?

Hyperosmolar hyperglycemic state (HHS) is one of two serious metabolic derangements that occur in patients with diabetes mellitus (DM). It is a life-threatening emergency that, although less common than its counterpart, diabetic ketoacidosis (DKA), has a much higher mortality rate, reaching up to 5-10%.

What is the recommended treatment for hypoglycemia?

If you have symptoms of hypoglycemia, do the following: Eat or drink 15 to 20 grams of fast-acting carbohydrates. These are sugary foods without protein or fat that are easily converted to sugar in the body. Try glucose tablets or gel, fruit juice, regular — not diet — soft drinks, honey, and sugary candy.

Does HHS have ketones?

Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of type 2 diabetes. It involves extremely high blood sugar (glucose) level without the presence of ketones.

What is honk called now?

Other names. Hyperosmolar hyperglycemic nonketotic coma (HHNC), hyperosmolar non-ketotic coma (HONK), nonketotic hyperosmolar coma, hyperosmolar hyperglycemic nonketotic syndrome (HHNS) Specialty. Endocrinology.