Hyperglycemic, hyperosmolar syndrome in feline diabetics. Hyperosmolar hyperglycemic nonketotic syndrome, or hhns, is a serious condition most frequently seen in older persons. Hyperosmolar hyperglycemic state diabetes care american. A diagnosis of hhs is made by the medical team based on the. Treatment of hyperglycaemic hyperosmolar nonketotic syndrome. Hyperosmolar diabetic coma ketotic and nonketotic jama. Client concerns included polydipsia, polyuria, and lethargy. Clinical and metabolic characteristics of hyperosmolar. Hyperglycemic hyperosmolar nonketotic syndrome hhns is one of the most severe acute complications of diabetes. Hyperglycemia hyperosmolar non ketotic coma ppt xpowerpoint. Hyperglycemic, hyperosmolar, nonketotic coma in a ketosis. The name changed from honk hyperosmolar non ketotic coma to hyperosmolar hyperglycaemic state to allow for the fact that some patients may be extremely ill but not comatose and may also be mildly ketotic and acidotic. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Hyperglycemic hyperosmolar nonketotic syndrome medind.
Colorado hyperosmolar nonketotic coma hnc, reportedly first described as a clinical entity by frerichs 1 more than 80 years ago, has had a resurgence of interest since sament and schwartz 2 redescribed it in 1957. Hyperglycemic hyperosmolar nonketotic syndrome with. These labels include hyperosmolar nonketotic coma, hyperosmolar hyperglycemic nonketotic coma, and hyperglycemic hyperosmolar nonketotic syndrome hackel, 2014. Nonketotic diabetic coma has emerged as a distinct syndrome mediated by the hyperosmolarity of the blood. The sudden increased level of sugar result in hypotension and tachycardia, complicating into coma and death. Hyperosmolar hyperglycemic state hhs endocrine and. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Hyperglycemic hyperosmolar nonketotic syndrome researchgate. Hyperglycemic, hyperosmolar syndrome was seen in older cats that were often long. 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. 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. Hyperosmolar nonketotic crises occur chiefly in mild, maturityonset diabetics, yet present a medical emergency carrying a high mortality. The hallmark of hhns is profound dehydration, marked hyperglycemia, and often some degree of neurologic impairment with mild or no ketosis 1. Typically, the patient, a middleaged or old person with diabetes mellitus of recent onset or without previous history of the disease, lapses into stupor and unconsciousness after manifesting prodromal neurological symptoms, such as.
In a series of 22 patients with the hyperosmolar hyperglycemic nonketotic syndrome managed during a fiveyear period in a community hospital setting. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. Especially, there are limited reportsof the high intensity on t1weighted images and a low intensity on t2weighted images in bothputamina in nonketotic hyperglycemic hemichorea. The purposes of this study were to characterize the hyperglycemic, hyperosmolar syndrome hhs, also known as nonketotic hyperosmolar diabetes, in cats. Hhs is characterized by severe hyperglycemia, profound dehydration, and is. Arieff and carrolls diagnostic criteria included a blood glucose level.
The hyperosmolarity in this syndrome is due to either gross hyperglycemia or. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome hhns. Hyperosmolar hyperglycemic nonketotic syndrome sciencedirect. Careful monitoring of glucose levels and ensuring adequate hydration in patients at risk of hhns, including those receiving medications that interfere with the. Hyperosmolar hyperglycemic state and diabetic ketoacidosis may represent opposite ends of the spectrum of decompensated diabetes that differ in the time of onset, the degree of severity of ketosis. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of.
Clinical and metabolic data of twenty patients with hyperosmolar nonketotic coma hnc and ten patients in ketoacidosis da are compared. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with. Seven died, but in five death was probably not due to the hyperosmolar state.
Seven of these were complicated by other illnesses. Diabetes increases your risk for many serious health problems. Twelve cases of diabetic hyperosmolar coma without ketosis are described in ten patients. View and download powerpoint presentations on hyperglycemia hyperosmolar non ketotic coma ppt. Hhns is an emergency caused by very high blood sugar, often over 600 mgdl.
Hyperosmolar hyperglycemic nonketotic syndrome the american. 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. Evaluation at presentation revealed profound dehydration, lactic acidosis, and azotemia. Diagnosis and management of hyperglycemic emergencies. Management of hyperosmolar hyperglycaemic state in adults. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Hyperglycemic hyperosmolar state hhs is an acute complication associated with diabetes mellitus. Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva tion of blood glucose, hyperosmolarity, and little or no ketosis. Hyperosmolar hyperglycemic state linkedin slideshare.
A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. The treatment for nonketotic hyperglycinemia is based on. This may in part be due to a lack of awareness of the clinical presentation, and of the principles of treatment. Hyperosmolar hyperglycaemic state symptoms, diagnosis. Department of pediatrics, advanced pediatrics center, post graduate. 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. Hyperosmolar hyperglycemic state on the web most recent articles. Diabetic ketoacidosisv hyperglycemic hyperosmolar nonketotic syndrome hhnk cause. The management of the hyperosmolar hyperglycaemic state hhs. Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic hyperosmolar coma nkhhc. Hhs has been known by several other names in the past.
Symptoms include signs of dehydration, weakness, legs cramps, trouble seeing, and an altered level of. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed. Hospitalizations for hyperosmolar hyperglycemic nonketotic syndrome as firstlisted diagnosis in adults with diabetes, united states. In this study, hyperosmolarity was not related to coma or to final outcome of treatment. 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 hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. The emergencies of diabetic ketoacidosis and a nonketotic hyperosmolar state can occur with both type 1 and type 2 diabetes. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. Now it is being diagnosed with increasing frequency in obese children with type 2 diabetes mellitus. Rhabdomyolysis is an unusual but underestimated complication of hhns 2. In both syndromes, there is insufficient insulin levels to transport.
Find powerpoint presentations and slides using the power of, find free presentations research about hyperglycemia hyperosmolar non ketotic coma ppt. The hyperosmolar hyperglycemic state hhs is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of. 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. Patients were managed with relatively small amounts of fluid, and the type of.
The first step of treatment involves careful monitoring. Hyperosmolar hyperglycemic nonketotic syndrome hhns. Hyperosmolarity without nonketotic hyperglycemic hyperosmolar coma due to type 2 diabetes mellitus. Also referred to as hyperosmolar hyperglycemic state hhs, nonketotic hyperosmolar coma nkhoc is an acute complication of diabetes meillitus type 2. Hyperosmolar hyperglycemic state ada pdf hyperosmolar hyperglycemic nonketotic syndrome, or hhns, is a serious condition most frequently seen in older persons. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva ada american diabetes association. How do i view different file formats pdf, doc, ppt, mpeg on this site. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. With the correct treatment and recommended lifestyle changes, many people with diabetes are able to prevent or delay the onset of complications.
This syndrome is characterised by severe hyperglycaemia, a marked increase in serum osmolality, and clinical evidence of dehydration without significant accumulation of ketoacids. Diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs appear as 2 extremes in the spectrum of diabetic decompensation. Abstract a 24yearold juvenile diabetic with many episodes of diabetic ketoacidosis presented with hyperglycemic, hyperosmolar, nonketotic coma that progressed rapidly to death despite vigorous conventional. Changing the name to hyperosmolar hyperglycaemic state hhs allows for the fact that some people with severely raised blood glucose may.
Hyperosmolar nonketotic coma is a serious disorder reported to have a mor tality varying between 20 and 7 0 %. Neurologic and respiratory signs occurred frequently. Hyperglycaemic hyperosmolar state hhs is a medical emergency, which differs from diabetic ketoacidosis dka and requires a different approach. Common precipitating factors in hnc included infection, dehydration and administration of diabetogenic drugs. Hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. Diabetic ketoacidosis occurs more commonly with type 1. Glycerol and hyperosmolar nonketotic coma pdf free download. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Limitations of various guidelines include implementation in settings with an infrastructure different from that specified in the guidelines of. Get a printable copy pdf file of the complete article 798k.
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