Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. It most often occurs in type 2 diabetes, often in the setting of physiologic stress.
What are the signs and symptoms of hyperosmolar hyperglycemic state?
Symptoms
- Blood sugar level of 600 milligrams per deciliter (mg/dL) or 33.3 millimoles per liter (mmol/L) or higher.
- Excessive thirst.
- Dry mouth.
- Increased urination.
- Warm, dry skin.
- Fever.
- Drowsiness, confusion.
- Hallucinations.
What is hyperglycaemic hyperosmolar Nonketotic state?
Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS), also known as Hyperosmolar Hyperglycaemic State (HHS) is a dangerous condition resulting from very high blood glucose levels. HHNS can affect both types of diabetics, yet it usually occurs amongst people with type 2 diabetes.
What lab test confirms HHNS?
Diagnosis. HHNS is diagnosed based on symptoms and by measuring blood glucose levels, which can be performed with a finger stick. A blood glucose level of 600 mg/dL and low ketone levels are the main factors for diagnosis of HHNS.
What causes hyperosmolar hyperglycemic state?
Symptoms and Causes
HHS occurs when the blood sugar of a person with diabetes becomes too high (hyperglycemia) for a long time. The extra sugar is passed into the urine, which causes the person to urinate frequently. As a result, he or she loses a lot of fluid, which can lead to severe dehydration (extreme thirst).
How is Hyperosmolarity diagnosed?
Current diagnostic HHS criteria include a plasma glucose level >600 mg/dL and increased effective plasma osmolality >320 mOsm/kg in the absence of ketoacidosis.
How is hyperosmolar hyperglycemic state treated?
Treatment typically includes:
- Fluids given through a vein (intravenously) to treat dehydration.
- Insulin given through a vein (intravenously) to lower your blood sugar levels.
- Potassium and sometimes sodium phosphate replacement given through a vein (intravenously) to help your cells function correctly.
How is hyperosmolar hyperglycemic state diagnosed?
Hyperosmolar hyperglycemic state is diagnosed by blood tests that show very high levels of glucose and very concentrated blood. Treatment is intravenous fluids and insulin. Complications include coma, seizures, and death.
Which is worse DKA or HHS?
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’s the difference between HHS and DKA?
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.
What does hyperosmolar mean?
The loss of water also makes the blood more concentrated than normal. This is called hyperosmolarity. It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances. This draws the water out of the body’s other organs, including the brain.
What do you do if your BM is high?
drink plenty of sugar-free fluids – this can help if you’re dehydrated. exercise more often – gentle, regular exercise such as walking can often lower your blood sugar level, particularly if it helps you lose weight. if you use insulin, adjust your dose – your care team can give you specific advice about how to do this.
How can HHS be prevented?
Take the following steps to help prevent HHS:
- Know the early warning signs of HHS, and don’t ignore them.
- Check your blood sugar levels regularly, especially when you feel sick.
- Take your prescribed medications regularly and consistently.
- Maintain a healthy diet as recommended by your doctor.
- Exercise regularly.
What medications can precipitate a hyperosmolar hyperglycemic state?
Which drugs increase the risk for hyperosmolar hyperglycemic state (HHS)?
- Alcohol and cocaine.
- Anesthesia.
- Antiarrhythmics (eg, encainide and propranolol)
- Antidiabetic medications (sodium-glucose cotransporter-2 inhibitors)
- Antiepileptics (eg, phenytoin)
What are the warning signs of diabetic ketoacidosis?
Symptoms
- Excessive thirst.
- Frequent urination.
- Nausea and vomiting.
- Stomach pain.
- Weakness or fatigue.
- Shortness of breath.
- Fruity-scented breath.
- Confusion.
What is cerebral edema and why is it a concern with hyperosmolar hyperglycemic syndrome HHS patients?
Cerebral edema is a rare, but frequently fatal, complication in HHS. This occurrence is usually seen in newly diagnosed diabetic children with DKA. Cerebral edema occurs from rapid lowering of glucose levels and an ensuing rapid drop in plasma osmolarity.
When do you stop insulin in HHS?
dose the insulin infusion conservatively
- Don’t use a bolus.
- The starting dose is 0.05 U/kg/hr (half of the initial dose used in DKA).
- The target should be to reduce the glucose by ~40-80 mg/dL per hour (2.2-4.4 mM). …
- Stop the insulin when glucose approaches ~300 mg/dL.
How much insulin do you need for HHS?
In adults, insulin should be started with an initial intravenous bolus of 0.1 units per kg, followed by a continuous infusion of 0.1 units per kg per hour until the blood glucose level falls to 250 to 300 mg per dL (13.9 to 16.7 mmol per L).
What lab values indicate DKA?
Laboratory findings consistent with the diagnosis of diabetic ketoacidosis (DKA) include blood pH < 7.3, serum bicarbonate < 18 mEq/L, anion gap > 10 mEq/L and increased serum osmolarity.
What is the mortality rate for HHS?
The mortality rate for patients with HHS is between 10 and 20 percent, which is approximately 10 times higher than that for DKA . The mortality rate for hyperglycemic crisis declined between 1980 and 2009 .
What is the range of hyperglycemia?
Hyperglycemia is blood glucose greater than 125 mg/dL (milligrams per deciliter) while fasting (not eating for at least eight hours; a person with a fasting blood glucose greater than 125 mg/dL has diabetes).
What causes honk?
Causes of HONK
Causes of hyperglycaemic hyperosmolar non-ketotic coma may include undiagnosed type 2 diabetes that has been developing over a number of years. Alternatively, HONK could be brought on by diabetic medication not being taken or very high blood glucose resulting from a period of illness.
What is the meaning of HHS?
HHS: The Department of Health and Human Services of the US government, which has jurisdiction over public health, welfare, and civil rights issues and is the highest-level US government body with such jurisdiction.