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.
What causes HHNS?
HHNS is typically brought on by:
An infection, such as
pneumonia
or a urinary tract infection. Poor management of blood sugar and/or not taking diabetes medications as prescribed. Taking certain medications, such as glucocorticoids (which alter glucose levels) and diuretics (which increase urine output)
What is 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.
How do you manage HHS?
Treatment of HHS
Treatment is
0.9% (isotonic) saline solution
at a rate of 15 to 20 mL/kg/hour, for the first few hours. After that, the corrected sodium should be calculated. If the corrected sodium is
Why is HHS worse than DKA?
Patients with HHS have been reported to have
higher insulin concentration
(demonstrated by basal and stimulated C-peptide levels),12 and reduced concentrations of FFA, cortisol, growth hormone, and glucagon compared to patients with DKA.
Why is HHS more common in diabetes 2?
The condition most commonly occurs in people with type 2 diabetes. It's often triggered by illness or infection. In diabetic hyperosmolar syndrome,
your body tries to rid itself of the excess blood sugar by passing it into your urine
.
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 does hyperosmolar mean?
: the condition especially of
a bodily fluid of having abnormally high osmolarity
hyperosmolarity occurs in dehydration, uremia, and hyperglycemia with or without ketoacidosis— R. W. P. Cutler.
Why is weight management so important for those with diabetes?
Eating well and maintaining a stable weight
is particularly important for people with diabetes, so we figured that learning more about weight management was long overdue. Lowering waist measurement will help to improve your blood sugar control and reduce the risk of diabetes complications.
What is the immediate aim of treatment for HHNS?
Patients presenting with HHNS also have significant depletion of potassium and other electrolytes that will need to be replaced. The principal goal at the outset of therapy must be
restoration of the intravascular volume to assure adequate perfusion of vital organs
.
How do you confirm HHS?
Your doctor will examine you, ask about your symptoms, and
order a blood test to check your blood sugar level
. A very high blood sugar level (over 600 mg/dL) with low ketone levels (acids in blood and urine) will help the doctor make a diagnosis of HHS.
When do you stop insulin in HHS?
- 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.
What Insulin is used for HHS?
Although many patients with HHS respond to fluids alone,
IV insulin
in dosages similar to those used in diabetic ketoacidosis (DKA) can facilitate correction of hyperglycemia.
Is HHS worse than 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 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.
Can you have ketones in HHS?
HHS is
a potentially life-threatening emergency
It does not usually lead to the presence of ketones in the urine, as occurs in diabetic ketoacidosis (DKA), which is why it was previously referred to as HONK (hyperglycaemic hyperosmolar non-ketotic coma).
