One of the cases was a 59yearold female who had suffered from a metastatic brain tumor. Hhns or hns is hyperosmolar hyperglycemic nonketotic syndrome. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva ada american diabetes association. Polyuric dehydration caused by di can lead to honkc. 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. Hyperosmolar nonketotic coma definition of hyperosmolar.
Study terms hyperglycemia hyperosmolar nonketotic. It is characterized by a syndrome of serious hyperglycemia, hypernatremia, dehydration, high plasmatic osmotic pressure, and no obvious ketoacidosis, as well as different levels of consciousness disorder or coma. Two cases of hyperosmolar nonketotic coma, in which both the patients recovered, were presented. Treatment of hyperglycaemic hyperosmolar nonketotic. See causes and risk factors by clicking the pdf icon above. Very high blood glucose levels often over 40 mmoll develop as a result of a combination of illness, dehydration and an inability to take normal diabetes medication due to the effect of illness.
How to recognize and intervene for hyperosmolar hyperglycemic. The latter designation is a misnomer, because a mild degree of ketosis often is present, and a true coma is uncommon. These disorders can occur in both type 1 and type 2 dm. The mortality rate of hyperosmolar hyperglycemic state ranges from 10 to 50 percent, higher rate than that of diabetic ketoacidosis 1. Traumatic brain injuries are the most frequent cause. Diabetic coma is a reversible form of coma found in people with diabetes mellitus. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Dec 10, 2018 hyperosmolar hyperglycemic nonketotic syndrome hhns mostly affects elderly people. Oct 17, 2016 hyperglycemic hyperosmolar syndrome by. 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. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped.
Hyperosmolar nonketotic coma usually type 2 in which an extremely high blood sugar level and dehydration alone are sufficient to cause unconsciousness. It is a medical emergency three different types of diabetic coma are identified. Hyperglycaemic hyperosmolar nonketotic coma is a dangerous condition brought on by very high blood glucose levels in type 2 diabetes above 33 mmoll. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the.
Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. The most obvious part of a comet when it is close to the sun. Hhns can happen to people with either type 1 or type 2 diabetes, but it occurs more often in people with type 2. It is a condition in which the blood has a high concentration of salt sodium, glucose, and other substances. Hyperosmolar hyperglycaemic state symptoms, diagnosis. Olanzapineinduced hyperglycaemic coma and neuroleptic malignant syndrome. Hhs is different from diabetic ketoacidosis dka and treatment requires a different approach. 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.
Hyperosmolar hyperglisemic nonketotic coma honkc is a rare complication of type 2 diabetes mellitus dm. This syndrome is characterised by severe hyperglycaemia, a marked increase in serum osmolality, and clinical evidence of dehydration without significant accumulation of ketoacids. Many patients with nonketotic hyperglycemia exhibit hypernatremia due to the free water loss induced by the osmotic diuresis. Find out information about hyperosmolar nonketotic coma.
Hhns is hyperosmolar hyperglycemic nonketotic syndrome. It is a diabetes complication that occurs in dehydration and hyperglycemia. It consists of a diffuse luminous nebulous cloud of gas and dust that surrounds the comets nucleus and is formed by the sublimation of ices and ejection of dust particles from the nucleus. Diabetic ketoacidosis usually type 1 advanced enough to result in unconsciousness from a combination of a severely increased blood sugar level, dehydration and shock, and exhaustion. In contrast to dka, the onset of hhns is usually insidious. Diabetic hyperosmolar syndrome symptoms and causes. Mar 06, 2012 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 hyperglycemic state linkedin slideshare.
Hyperosmolar hyperglycemic nonketotic syndrome and. Hyperglycemic hyperosmolar nonketotic syndrome occurs at a frequency of 17. Hhs is characterised by severe hyperglycaemia with marked serum. Precipitating causes are usually infection or insulin. Hyperosmolar hyperglycemic state on the web most recent articles. 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 in conditions marked by an excess of steroids, as. In most medical contexts, the term diabetic coma refers to the diagnostical dilemma posed when a physician is confronted with an unconscious patient about whom nothing is known except that. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes.
Hyperosmolar nonketotic hyperglycaemia listed as hnkh. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. If you continue browsing the site, you agree to the use of cookies on this website. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Hyperosmolar nonketotic coma is characterized by hyperglycemia, hyperosmolarity and dehydration in the absence of ketoacidosis. Blood sugar level of 600 milligrams per deciliter mgdl or 33. 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. The goals of treatment are to provide frequent patient monitoring, to treat the underlying cause and to gradually and safely. Clinical and metabolic characteristics of hyperosmolar nonketotic coma. Diabetic hyperglycemic hyperosmolar syndrome hhs is a complication of type 2 diabetes. Dka is characterized by hyperglycemia, ketone body formation and metabolic acidosis. Hyperglycemic hyperosmolar syndrome hhs, charac terized by extreme. Hyperosmolar hyperglycemic nonketotic syndrome hhns.
Hyperosmolar hyperglycemic state hhs endocrine and. Full text hyperosmolar nonketotic hyperglycemic coma. Treatment of hyperglycaemic hyperosmolar nonketotic syndrome. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious. Hyperglycaemic hyperosmolar nonketotic coma is a short term complication requiring immediate treatment by a healthcare professional. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum.
Diabetic ketoacidosis and hyperglycemic hyperosmolar. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. 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 dec 01, 2017 hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. Hyperosmolar hyperglycemic syndrome hhs is a clinical condition that arises from a complication of diabetes mellitus. Hyperglycemic hyperosmolar nonketotic syndrome medind. Hyperosmolar hyperglycemic state, hyperosmolar hyperglycemic syndrome, hyperosmolar hyperglycemic nonketotic coma, hyperglycemic hyperosmolar nonketotic coma, hyperglycemic dehydration syndrome, hyperosmolar nonketotic diabetic syndrome, diabetic hyperosmolar nonketotic state. It can occur as a complication of borderline and unrecognized diabetes mellitus, in. Hyperglycemic hyperosmolar nonketotic syndrome hhns caused by lack of insulin or insulin resistance with resulting hyperglycemia which causes osmotic diuresis. The name changed from honk hyperosmolar non ketotic coma to hyperosmolar. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Symptoms of honk before loss of consciousness and coma takes place, patients will display signs of.
Patients admitted to icu via ed with hhs hyperosmolar hyperglycemic. The brightest part of the coma is the central region nearest the surface of the nucleus, where the density of material being released is at. All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only. Hyperosmolar nonketotic coma article about hyperosmolar. 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.
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 hyperglycemia and hyperosmolarity in an eighteenmonthold child. Several days of deteriorating glycemic control, polyuria, and polydipsia are followed by increasing lethargy. Hyperosmolar hyperglycemic state an overview sciencedirect. Hyperosmolar nonketotic syndrome with hypernatremia. 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. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. Oct 10, 2014 the hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Pdf hyperglycemic hyperosmolar state after transsphenoidal. This increase in blood glucose is accompanied by increase in the osmolality of. 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%. Therefore, this merged platform can be considered a multi.
The hyperglycaemic hyperosmolar state hhs is a medical emergency. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. Buildup of ketones in the body ketoacidosis may also occur. What is hyperosmolar hyperglycemic nonketotic syndrome hhns. The management of the hyperosmolar hyperglycaemic state. These hormonal increases and poor insulin response combine to cause hyperglycemia.
The terms hyperglycemic hyperosmolar nonketotic state and hyperglycemic. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome hhns. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. Pdf overview of cerebral edema during correction of. Hyperosmolar nonketotic hyperglycaemia how is hyperosmolar. It was also named hyperglycemic hyperosmolar nonketotic state, but findings of moderate. Too much glucose in your blood also called hyperglycemia or high blood sugar can cause many problems. Diabetic hyperglycemic hyperosmolar syndrome definition diabetic hyperglycemic hyperosmolar syndrome hhs is a complication of type 2 diabetes. Oct 27, 2012 hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. Diabetic ketoacidosis and hyperosmolar hyperglycemic state. Clinical features, pathophysiology, renal function, acidbase balance, plasma cerebrospinal fluid equilibria and the effects of therapy in 37 cases. Hyperglycemic hyperosmolar nonketotic coma definition msh a serious complication of type 2 diabetes mellitus.
Hyperglycemia, hyperosmolar nonketotic syndrome in children. Hyperglycemic hyperosmolar syndrome in children diabetes. Define hyperglycemic hyperosmolar nonketotic coma hhnk. Dec 23, 2015 hyperosmolar hyperglycaemic state hhs occurs in people with type 2 diabetes. Although typically occurring in the elderly, hhs is presenting in ever younger adults and teenagers, often as the initial presentation of type 2 diabetes mellitus t2dm. 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 is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. Mar 22, 2006 diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are the two most serious metabolic complications of diabetes mellitus dm. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes. 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 state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes. In such cases, the profound water loss would counteract the hyperglycemia induced decrease in serum sodium levels 1, 2.
It involves extremely high blood sugar glucose level without the presence of ketones. Now it is being diagnosed with increasing frequency in. The loss of water also makes the blood more concentrated than normal. Severe hyperglycemic hyperosmolar nonketotic coma in a nondiabetic patient receiving aripiprazole. Hyperosmolar nonketotic hyperglycemic coma hnkhc is a rare, serious acute complication of diabetes mellitus. Hyperglycemic hyperosmolar nonketotic coma definition of. Diabetic hyperosmolar syndrome can take days or weeks to develop.
As glucose builds up in your blood, your body tries to get rid of it through your urine. Water shift from intracellular to intravascular compartment resulting in hypernatremia and increased osmolarity. This page includes the following topics and synonyms. Hyperosmolar hyperglycemic nonketotic syndrome, or hhns, is a serious condition most frequently seen in older persons. Hyperosmolar hyperglycemic state what you need to know.
Hyperosmolar hyperglycemic state is a relatively common, lifethreatening endocrine emergency that is reported in all age groups,1 but it most frequently affects older patients with type 2 diabetes. Research and education associate, wadsworth general hospital and cedars. Two cases of hyperosmolar nonketotic coma, in which both the. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. In these patients fluid and insulin administration may be followed by cerebral edema from an overly rapid decrement in plasma osmolality. The management of the hyperosmolar hyperglycaemic state hhs. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. This draws the water out of the bodys other organs, including the brain. According to cdc, the blood sugar is usually greater than 600800mgdl. 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. Start studying hyperglycemia hyperosmolar nonketotic syndrome vs. Assistant professor of medicine, ucla medical center. Hyperosmolar hyperglycemic state clinical presentation.
16 914 140 107 342 111 909 453 1414 724 1433 545 508 358 588 573 1541 1663 1346 819 1286 1488 1593 1144 297 330 92 343 1564 453 99 1289 1545 533 852 421 1162 781 1029 451 1099 286 530 1370 827 686 560