Hyperglycaemic hyperosmolar state hhs is a medical emergency, which differs from. Hyperglycaemic hyperosmolar nonketotic coma is a dangerous condition brought on by very high blood glucose levels in type 2 diabetes above 33 mmoll. 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. Sever hyperglycemic hyperosmolar nonketotic coma guidelinew a nondiabetic patient receiving aripiprazole. Hyperosmolar nonketotic coma in acromegaly jama jama. Traumatic brain injuries are the most frequent cause. The management of the hyperosmolar hyperglycaemic state hhs. It is less common than the other acute complication of diabetes, diabetic ketoacidosis dka. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed. Hyperosmolar nonketotic coma article about hyperosmolar.
Pdf hyperosmolar nonketotic hyperglycemic coma induced by. This pdf is available for free download from a site hosted by medknow publications. Hyperosmolar hyperglycemic nonketotic syndrome, or hhns, is a serious condition most frequently seen in older persons. 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. A case of a patient with hyperosmolar hyperglycemic state. Hhns is an emergency caused by very high blood sugar, often over 600 mgdl. Pattavina a 46yrold hypertensive man treated for 1 yr with apresoline 200 mg and propranolo1 240 mg daily, was admitted in deep coma, severely dehydrated, serum glucose 1 mgloo ml without ketonemia, normal serum coz, blood ph 7. Hyperosmolar hyperglycemic state hhs endocrine and. 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. Symptoms of honk before loss of consciousness and coma takes place, patients will display signs of. Clinical physiology of acidbase and electrolyte disorders. Hhs has gone through several diagnostic labels, including hyperosmolar nonketotic coma honk, hyperosmolar hyperglycemic nonketotic coma hhnc, and hyperglycemic hyperosmolar nonketotic syndrome hhns, because coma is present in a minority of those presenting nugent, 2005.
Nonketotic diabetic coma an overview sciencedirect topics. Hyperglycemic hyperosmolar nonketotic syndrome medind. We describe five patients with asymptomatic, nonketotic, severe hyperglycemia serum glucose concentrations between 45. Nonketotic hyperosmolar coma in the postoperative patient hyperosmolar nonketotic coma in the elderly diabetic deaths associated with diabetic ketoacidosis and hyperosmolar coma. 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. Download fulltext pdf hyperosmolar, nonketotic diabetic coma in infants. Blood biochemistry showed that their glucose, sodium, and potassium, were only slightly elevated, and so was the blood urea nitrogen content in plasma osmolality values inferred, which was less than 350 mosml, nonketotic diabetic hyperosmolar coma was also excluded. Hyperglycaemic hyperosmolar syndrome is a major acute complication of decompensated diabetes mellitus.
The nonketotic hyperosmolar hyperglycemic state usually occurs in cases of maturity onset diabetes or prediabetes, as in the two elderly patients discussed in this paper. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome hhns. Hyperglycemic hyperosmolar state hhs is an acute complication associated with diabetes mellitus. It can occur as a complication of borderline and unrecognized diabetes mellitus, in pancreatic disorders that interfere with the production of insulin, as a complication of extensive burns, and in conditions marked by an excess of steroids, as. Blood sugar level of 600 milligrams per deciliter mgdl or 33. With the multifaceted approach to head and neck cancer today, maintaining caloric intake by longterm enteral hyperalimentation is commonplace. Interesting imaging observations in 2 patients with involuntary movements and seizures n. The hyperglycaemic, hyperosmolar nonketotic syndrome. Hyperosmolar nonketotic coma definition of hyperosmolar. It is characterised by severe hyperglycaemia, hyperosmolality and dehydration in the absence of significant ketosis, afflicting principally middleagedtoelderly.
Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Predisposing factors for the diabetic hyperosmolar state jama. Like nonketotic hyperosmolar coma, diabetic ketoacidosis can have a significant impact on patient safety and can be investigated within a cause map, or a visual root cause analysis. Hyperosmolar hyperglisemic nonketotic coma honkc is a rare complication of type 2 diabetes mellitus dm. This syndrome is characterised by severe hyperglycaemia, a marked increase in serum osmolality, and clinical evidence of dehydration without significant accumulation of ketoacids. The goals of treatment are to provide frequent patient monitoring, to treat the underlying cause and to gradually and safely. A case of pituitary gigantism who had two episodes of diabetic ketoacidosis followed by complete recovery of diabetes. Hhs, formerly referred to as hyperosmolar nonketotic coma, may. Nonketotic hyperglycemiarelated epileptic seizures. View and download powerpoint presentations on hyperglycemia hyperosmolar non ketotic coma ppt.
The sudden increased level of sugar result in hypotension and tachycardia, complicating into coma and death. Find powerpoint presentations and slides using the power of, find free presentations research about hyperglycemia hyperosmolar non ketotic coma ppt. The incidence and risk factors for diabetic ketoacidosis diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome hyperglycemic hyperosmolar syndrome, previously called nonketotic hyperosmolar coma have not been reported in a national population of renal transplant renal transplantation recipients. Diabetic ketoacidosis and hyperosmolar nonketotic syndrome. Pdf hyperosmolar nonketotic hyperglycemic coma hnkhc is a serious, rare complication induced by. Nonketotic hyperosmolar coma usually develops more insidiously than diabetic ketoacidosis because the principal symptom is lethargy progressing to obtundation, rather than vomiting and an obvious illness.
Nonketotic hyperosmolar coma is a syndrome characterized by severe hyperglycemia blood glucose concentration of more than 600 mgdl, absence of or only very slight ketosis, nonketotic acidosis, severe dehydration, depressed sensorium or frank coma, and various neurologic signs that may include grand mal seizures, hyperthermia, hemiparesis, and positive. Hyperglycemic hyperosmolar nonketotic syndrome springerlink. Extremely high blood sugar levels are accompanied by dehydration due to inadequate fluid intake. There may be a relationship between excess growth hormone and the hyperosmolar state. Management of hyperosmolar hyperglycaemic state in adults. Hyperosmolar nonketotic hyperglycemic coma induced by methylprednisolone pulse therapy for acute rejection after liver transplantation. Links to pubmed are also available for selected references. Mar 06, 2012 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. Hyperosmolar nonketotic crises occur chiefly in mild, maturityonset diabetics, yet present a medical emergency carrying a high mortality.
Oct 28, 2016 diabetic hyperosmolar coma is, in some patients with diabetes or high blood sugar caused by dehydration of the incentives under the extremely elevated blood glucose, high serum sodium, plasma osmotic pressure increased, appearance of the neurological symptoms as the main performance of clinical syndrome, but. Along with the tremendous advantages of this form of nutrition, the disadvantage of hyperosmolar nonketotic diabetic acidotic coma is present. Nonketotic hyperosmolar coma is a life threatening metabolic derangement that can develop in people with diabetes mellitus, usually due to illness, infection or failure to monitor blood glucose. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is 1 of 2 serious metabolic derangements that occurs in patients with diabetes mellitus dm and can be a lifethreatening emergency. A complication of propranolol therapy by stephen podolsky and catherine g. Nonketotic hyperosmolar coma is a syndrome characterized by severe hyperglycemia blood glucose concentration of more than 600 mgdl, absence of or only very slight ketosis, nonketotic acidosis, severe dehydration, depressed sensorium or frank coma, and various neurologic signs that may include grand mal seizures, hyperthermia, hemiparesis, and positive babinski signs. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of. Pdf hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Hyperosmolarity, hypovolaemia, acidosis and loss of electrolytes if unchecked lead to coma. These labels include hyperosmolar nonketotic coma, hyperosmolar hyperglycemic nonketotic coma, and hyperglycemic hyperosmolar nonketotic syndrome hackel, 2014. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Abstract despite increasing recognition of nonketotic hyperosmolar coma, the pathophysiology of this syndrome, particularly the absence of ketoacidosis ka, remains obscure. Feb 26, 2019 nonketotic hyperosmolar coma is a life threatening metabolic derangement that can develop in people with diabetes mellitus, usually due to illness, infection or failure to monitor blood glucose. Get a printable copy pdf file of the complete article 539k, or click on a page image below to browse page by page.
Oct 31, 2017 hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus. Hyperosmolar hyperglycemic nonketotic syndrome hhnk hyperosmolar coma nonketotic hyperosmolar coma hyperosmolar nonketotic syndrome hyperosmolar hyperglycemic nonketotic coma nonketotic hyperglycemic hyperosmolar coma 3. Glycerol and hyperosmolar nonketotic coma pdf free download. The present article summarizes the recent guidance on. Hyperosmolar hyperglycemic nonketotic syndrome hhns, previously called hyperosmolar nonketotic coma honk, is a metabolic complication of diabetes mellitus characterized by hyperglycemia, extreme dehydration, hyperosmolar plasma, and various neurological manifestations. Unlimited viewing of the articlechapter pdf and any associated supplements and figures. Hyperosmolar hyperglycemic nonketotic coma in a patient.
Diabetic hyperosmolar syndrome can take days or weeks to develop. The two most common lifethreaten ing complications of diabetes mellitus include diabetic ketoacidosis dka and hyperglycemic. Full text is available as a scanned copy of the original print version. 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 coma in diabetes of adrenaline or other cardiac stimulant, or of. It develops slower than dka, typically in the course of several days, but has a.
The management of the hyperosmolar hyperglycaemic state in. Glycerol, an effective cerebral dehydrating agent, also has gluconeogenic properties, and can thereby elevate serum glucose to dangerously high levels in predisposed patients treated for cerebral edema. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes. May 17, 2015 hyperglycaemic hyperosmolar state hhs is a medical emergency, which differs from diabetic ketoacidosis dka and requires a different approach. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. Hyperglycemic, hyperosmolar, nonketotic coma developed in a 70yearold acromegalic woman during progesterone therapy. Fatty acid and carbohydrate metabolism in nonketotic. We performed a historical cohort study of 39,628 renal transplantation recipients in. Umpierrez the hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes.
Hyperglycemia hyperosmolar non ketotic coma ppt xpowerpoint. Diabetic ketoacidosis and the hyperglycemic hyperosmolar state are the most serious complications of diabetic decompensation and remain associated with excess mortality. This may in part be due to a lack of awareness of the clinical presentation, and of the principles of treatment. Brief report diabetic nonketotic hyperosmolar state. Nonketotic hyperosmolar coma nhc is characterized by severe hyperglycemia. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. Hyperosmolar hyperglycemic nonketotic coma in a patient undergoing emergency cholecystectomy you will receive an email whenever this article is corrected, updated, or cited in the literature. Although recent reports of this syndrome stress low levels of plasma growth hormone, this patient had abnormally high levels. Hyperosmolar hyperglycemic state, diabetic hhs vs dka. As opposed to most of the previously described patients with hyperglycemic, nonketotic, hyperosmolar coma, our. Hyperosmolar nonketotic hyperglycemic coma induced by. Therefore, nkhrelated epileptic seizures should be next considered. Hhs has been known by several other names in the past.
A thrombotic stroke or cerebropontine myelinolysis associated with high serum osmolarity and cerebral edema are wellknown complications of hyperosmolar nonketotic coma 1. Clinical features, pathophysiology, renal function, acidbase balance, plasma cerebrospinal fluid equilibria and the effects of therapy in 37 cases. Nonketotic hyperosmolar coma in a patient with type 1 diabetes. Dreschfeld 14 description of a nonketotic diabetic coma 1922 banting et al. Find out information about hyperosmolar nonketotic coma. Polyuric dehydration caused by di can lead to honkc. You can manage this and all other alerts in my account. Now it is being diagnosed with increasing frequency in. A 24yearold juvenile diabetic with many episodes of diabetic ketoacidosis presented with hyperglycemic, hyperosmolar, nonketotic coma that progressed rapidly to death despite vigorous conventional therapy with hypotonic fluids, insulin, and potassium. Hyperglycemic, hyperosmolar, nonketotic coma in a ketosis.
Hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. Although critical illness polyneuropathy cip is not included in the textbook differential diagnosis, there is one case report showing an association of cip to hyperosmolar nonketotic coma 2. Hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. Also referred to as hyperosmolar hyperglycemic state hhs, nonketotic hyperosmolar coma nkhoc is an acute complication of diabetes meillitus type 2. Hyperosmolar hyperglycemic state linkedin slideshare. The impacted goals for a hospital resulting from hospitalacquired diabetic ketoacidosis are very similar to those for nonketotic hyperosmolar coma. Insulin deficiency is the main underlying abnormality. Hyperosmolar hyperglycemic nonketotic syndrome presenting. Hyperosmolar hyperglycemic nonketotic diabetic coma.
One of the reasons of central diabetes insipidus cdi is metastatic malignancies. 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. An emerging pediatric problem hyperglycemic hyperosmolar state. It is a lifethreatening emergency that, although less common than its counterpart, diabetic ketoacidosis dka, has a much higher mortality rate, reaching up to 510%. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Hhs is characterized by severe hyperglycemia, profound dehydration, and is. Diabetic hyperosmolar nonketotic coma induced by central. Asymptomatic, nonketotic, severe hyperglycemia with. Treatment of hyperglycaemic hyperosmolar nonketotic syndrome.
Oct 27, 2012 hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. Hyperosmolar hyperglycemic nonketotic coma, a cause of delayed recovery from anesthesia you will receive an email whenever this article is corrected, updated, or cited in the literature. Hyperglycaemic hyperosmolar nonketotic coma is a short term complication requiring immediate treatment by a healthcare professional. Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine. Nonketotic hyperosmolar hyperglycemia during glycerol. Diabetic ketoacidosis and hyperglycemic hyperosmolar. The mortality rate of hyperosmolar hyperglycemic state ranges from 10 to 50 percent, higher rate than that of diabetic ketoacidosis 1.
Hhns is typically observed in elderly patients with noninsulindependent diabetes. Reversibile quadriplegia and nonketotic hyperosmolar coma. Pdf hyperosmolar, nonketotic diabetic coma in infants. 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. Clinical presentation, diagnosis, and treatment diabetes care 2014. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked eleva ada american diabetes association. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness.
Most frequently breast and lung cancer and less frequently colorectal cancer can cause pituitary metastasis. Hyperosmolar hyperglycemic nonketotic syndrome hhns. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped. Hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. 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 lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. The latter designation is a misnomer, because a mild degree of ketosis often is present, and a true coma is uncommon. Two diabetic children with nonketotic hyperosmolar coma were treated successfully. Diabetic hyperosmolar syndrome symptoms and causes mayo.