How does HHS differ from DKA?

Although both conditions can occur at any age, diabetic ketoacidosis typically develops in younger patients, less than 45 years, who have little or no endogenous insulin production, whereas HHS usually occurs in much older non-insulin-dependent patients (who are often greater than 60 years old).

Similarly, is HHNS the same as HHS?

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.

Similarly, why is blood sugar higher 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.

In this manner, 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%.

Can HHS lead to DKA?

PRECIPITATING CAUSES In patients with established diabetes, precipitating factors for DKA include infections, intercurrent illnesses, psychological stress, and poor compliance with therapy. Most patients with HHS have type 2 diabetes. HHS is the initial manifestation of diabetes in 7–17% of patients.

What is the treatment for HHS?

Treatment typically includes:

Intravenous fluids to counter dehydration.
Intravenous insulin to lower your blood sugar levels.
Intravenous potassium, and occasionally sodium phosphate replacement to help your cells function correctly.

How do you manage HHS?

Treatment. Treatment consists of IV saline, correction of hypokalemia, and IV insulin (1). Treatment is 0.9% (isotonic) saline solution at a rate of 15 to 20 mL/kg/h, for the first few hours.

Why are there no ketones in HHS?

HHS is a potentially life-threatening emergency Ketones develop when the blood glucose level is high due to lack of insulin which is needed to allow glucose to enter the cells for energy. Because people with Type 2 diabetes may still be producing some insulin, ketones may not be created.

What causes hyperosmolar hyperglycemic state?

Causes. Also, certain drugs, such as corticosteroids, can raise blood glucose levels and cause hyperosmolar hyperglycemic state. Drugs such as diuretics, which people often take to treat high blood pressure, can worsen dehydration and trigger hyperosmolar hyperglycemic state.

How does HHS happen?

Hyperglycemic hyperosmolar syndrome (HHS) is a potentially life threatening condition involving extremely high blood sugar (glucose) levels. When your blood sugar gets too high, the kidneys try to compensate by removing some of the excess glucose through urination.

How is hyperosmolar hyperglycemic state diagnosed?

What are the ADA diagnostic criteria for hyperosmolar hyperglycemic state (HHS)?

Plasma glucose level of 600 mg/dL or greater.
Effective serum osmolality of 320 mOsm/kg or greater.
Profound dehydration, up to an average of 9 L.
Serum pH greater than 7.30.
Bicarbonate concentration greater than 15 mEq/L.

What does HHS stand for?

health and human services

What does hyperosmolar mean?

Medical Definition of Hyperosmolar Hyperosmolar: In biochemistry, pertaining to an osmolar concentration of the body fluids that is abnormally increased.

How long does it take DKA to develop?

SIGNS AND SYMPTOMS DKA can develop in less than 24 hours. 3 Metabolic changes occur one and one half to two hours earlier in patients who are managed only with a short-acting insulin such as lispro (Humalog).

Why is the anion gap important to follow in the treatment of DKA?

Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia.

What is hyperglycemic hyperosmolar state?

Hyperosmolar hyperglycemic state (HHS) is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness.

What is Kussmaul breathing?

Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure. It is this latter type of breathing pattern that is referred to as Kussmaul breathing.

Which 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 [SGLT-2] inhibitors)
Antiepileptics (eg, phenytoin)

Why does HHS cause dehydration?

It's often triggered by illness or infection. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing it into your urine. Left untreated, diabetic hyperosmolar syndrome can lead to life-threatening dehydration. Prompt medical care is essential.

What is hyperglycemic crisis?

Hyperglycemic crisis is a metabolic emergency associated with uncontrolled diabetes mellitus that may result in significant morbidity or death. Acute interventions are required to manage hypovolemia, acidemia, hyperglycemia, electrolyte abnormalities, and precipitating causes.

Why is DKA more common in type 1?

What Causes DKA? It usually happens because your body doesn't have enough insulin. Your cells can't use the sugar in your blood for energy, so they use fat for fuel instead. People with type 1 diabetes are at risk for ketoacidosis, since their bodies don't make any insulin.

What is the opposite of ketoacidosis?

Despite the similarity in name, ketosis and ketoacidosis are two different things. Ketoacidosis refers to diabetic ketoacidosis (DKA) and is a complication of type 1 diabetes mellitus. It's a life-threatening condition resulting from dangerously high levels of ketones and blood sugar.

What lab values indicate DKA?

Diabetic ketoacidosis is typically characterized by hyperglycemia over 250 mg/dL, a bicarbonate level less than 18 mEq/L, and a pH less than 7.30, with ketonemia and ketonuria.

How rapidly is fluid volume replaced in DKA?

Fluid loss averages approximately 6–9 L in DKA. The goal is to replace the total volume loss within 24–36 hours with 50% of resuscitation fluid being administered during the first 8–12 hours.