Dka is responsible for more than 500,000 hospital days per year 1,2 at an estimated annual direct medical expense and indirect cost of 2. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. Diabetic ketoacidosis and hyperosmolar coma harrisons manual. Diabetic ketoacidosis and hyperosmolar hyperglycemic state.
Hyperosmolar hyperglycemic state hhs honk, nkhc, hhnk dka insulin levels very low ketoacidosis profound glucose 600 hco3 5 15 osm 300 325 age young onset acute. The diagnosis of hhs in the usa is based on total rather than effective osmolality. Although it can occur in patients with type 2 diabetes during periods of severe. Diabetic ketoacidosis and hyperosmolar crisis in adults. The diagnosis of dka is based on disease severity in the usa, which differs from the uk. These disorders can occur in both type 1 and type 2 dm. Hyperosmolar hyperglycemic state, diabetic hhs vs dka. Dka is characterized by hyperglycemia, ketone body formation and metabolic acidosis. Although dka and hhs are discussed as separate entities, they represent points along a spectrum of hyperglycemic emergencies due to poorly controlled diabetes. Study dka vs hhs flashcards at proprofs will help distinguish btw dka and hhs. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious hyperglycemic emergencies in patients with type 1 and type 2 diabetes. We present a case of diabetic ketoacidosis, known as one of the most serious metabolic complications of diabetes. Dka usually occurs as a consequence of absolute or relative insulin deficiency that.
Diabetic ketoacidosis dka is an acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention for successful treatment. Hhs formerly known as hyperosmolar nonketotic state. Pdf hyperglycemic crises in adult patients with diabetes. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Management of diabetic ketoacidosis and hyperosmolar. Dka accounts for more than 150,000 hospital admissions per year in the. For more than 30 yr, our group, in a series of prospective, randomized clinical studies, has investigated the pathogenesis and evolving strategies of the treatment of hyperglycemic crises.
The criteria for hyperglycemic hyperosmolar state hhs include. This presentation was present by my friend during emergency posting seminar with dr. Diabetic ketoacidosis dka, hyperglycemic hyperosmolar. Dka hhs ispad consensus guidelines pediatric diabetes. Mosbys pathophysiology memory notecards free ebook download as pdf file. On the quiz, you will be tested on how it is triggered and its symptoms. The ada says the annual rate for dka ranges from 4. Hyperosmolar hyperglycemic state how to manage your. They are both potentially lifethreatening when not managed correctly. Protocol for management of adult patients with dka or hhs. Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state. Hhs are the two most serious acute metabolic complications of diabetes. Diabetic ketoacidosis dka and hyperosmolar hyperglycaemic state hhs remain two of the most commonly encountered metabolic emergencies. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes.
Dka may occur, and some patients with hhs, especially when. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are the two most serious metabolic complications of diabetes mellitus dm. Dka and hyperosmolar syndrome pearls and pitfalls corey m. Pdf treatment of diabetic ketoacidosis dkahyperglycemic. Treatment of diabetic ketoacidosis dkahyperglycemic. Guidelines for the management of patients with dka and hhs in the ed. Though there are many differences between dka and hhs, the basic problem is associated with insulin deficiency. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs cause major morbidity and significant mortality in patients with diabetes mellitus. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. Guidelines for the management of patients with dka and hhs. The two most important pathophysiologic mechanisms for dka and hhs are significant insulin deficiency and increased concentration of counterregulatory hormones such as glucagon, catecholamines, cortisol, and growth hormone, figure 1 64,65,66. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped. Patient is alert and demonstrates interest in eating b. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are diabetic emergencies that cause high morbidity and mortality.
To be aware of the different algorithmic treatment protocols for dka and hhs. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are. Prebreakfast administer both glargine and aspart dose according to premeal aspart order set. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. Table 1 outlines the diagnostic criteria for dka and hhs. What is dka and hhs hhns, and what does the nclex expect rn and lpn nursing students to know for their board exams. Treatmentofdkaandhhsalso differs with respect to timing of fluid and insulin. Dka occurs most frequently but not exclusively in people with type 1 diabetes mellitus, who are absolutely insulindeficient. Diabetic ketoacidosis dka is a state of uncontrolled diabetes and it is characterized by hyperglycemia, a high anion gap acidosis, and the presence of ketonemia and ketonuria ketone bodies in the blood and urine. Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dl, a ph less than 7. We were confronted with rapid neurological deterioration and unseen glycaemic values, which reached almost 110 mmoll, subsequently resulting in hyperkalaemia and lifethreatening dysrhythmias. Diabetic ketoacidosis dka is the most common hyperglycemic emergency in patients with type 1 and type 2 diabetes mellitus.
Hhs dka hhs glucose 250600 600 sodium 1255 5145 potassium normalinc normal bicarbonate 7. Patients with sc insulin pump safer to disconnect pump, start iv insulin for mild dka, interrogate pumpflow issue, may discuss with endocrinologist 7. Hyperglycemic crises in adult patients with diabetes. Dka results from deficiency of circulating insulin and increased levels of the counterregulatory hormones. Precipitating causes are usually infection or insulin. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Lets break it down so that you can understand exactly what ketosis is and how it differs from ketoacidosis. In brief diabetic ketoacidosis dka and hyperosmolar hyperglycemic syndrome hhs are two acute complications of diabetes that can result in increased morbidity and mortality if not efficiently and effectively treated. Diabetic ketoacidosis an overview sciencedirect topics. Diabetic ketoacidosis and hyperglycemic hyperosmolar. Unl ike the usa, the uk has separate guidelinesfordkaandhhs. In hhs, begin insulin administration at a dose of 0.
Hhs pts may be very sensitive to exogenous insulin 6. Dka and hhs rarely results from the metabolic complications of hyper glycemia or metabolic acidosis but rather relates to the. Diabetic ketoacidosis symptoms, diagnosis and treatment. To understand the pathogenesis of dka and hhs and why they are different. Melissa korpik school maslows hierarchy of needs mental health nursing abraham maslow self actualization therapy tools play therapy music therapy therapy activities nclex.
Dka vs hhs dka means diabetic ketoacidosis and hhs means hyperosmolar hyperglycemic syndrome. Dka and hhs absence of insulin increased glucagon increased diabetogenic hormones oxidation of free fatty acids ketones fuel source of glucose moa. Hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus. Dka is characterized by ketoacidosis and hyperglycemia, while hhs usually has more severe hyperglycemia but no ketoacidosis table 1. According to the american diabetes association ada, while dka has a death rate of less than 5%, that figure can reach around 15% for hhs. Complications may include seizures, disseminated intravascular coagulopathy. Largescale studies to determine optimal management of dka and hhs are lacking.
Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. This quiz and worksheet combo will test your knowledge of diabetic ketoacidosis dka. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. This is the first reported live case with such high values of blood glucose and a. Hhs is associated with a significant morbidity and higher mortality than dka and must. Hhs lacks the marked lipolysis, ketonemia, and acidosis associated with dka. Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the two most serious acute metabolic complications of diabetes.
Other electrolyte imbalances and complications associated with hhs. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Pathophysiology diabetic ketoacidosis dka is a complex disordered metabolic state characterised by hyperglycaemia, acidosis, and ketonaemia. Thirty years of personal experience in hyperglycemic. Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a consequence of the underlying precipitating causes rather than a result of the metabolic. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. In both syndromes, there is insufficient insulin levels to transport.
Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious acute metabolic emergencies in type 1 and type 2 diabetes. Overlap between the characteristic features of hhs and dka may occur, and some. Give some form of normal saline and when serum glucose reaches 200 mgdl dka or 300 mgdl hhs, give d5w with ns bicarbonate. Greater reductions in potassium dose may be necessary if patient is anuric b. Diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs appear as 2 extremes in the spectrum of diabetic decompensation. 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.
Page 1 of 7 hyperglycemic emergency management dkahhs1. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute complications of diabetes. Treatment of patients with dka and hhs utilizes significant health care resources. Dka guideline for diagnosis hhs guideline for diagnosis.
When comparing the two, hhs has a higher mortality. To understand the prevalence of diabetes in the united states. Both dka and hhs are the two complications of diabetes mellitus. The insulin deficiency of dka can be absolute in patients with t1d or relative as observed in patients with t2d in the presence of.
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