Hyperosmolar Hyperglycemic Nonketotic Syndrome, or HHNS, is a serious condition most frequently seen in older persons. HHNS can happen. Hyperosmolar hyperglycemic state is a life-threatening emergency manifested by marked eleva- ADA = American Diabetes Association. Hyperosmolar hyperglycemic state is a life-threatening emergency on recommendations from the American Diabetes Association (Figure 2).

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Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

Patients with DKA who had hjperglycemic vomiting or had been on diuretics may present with significant hypokalemia. In cases when the serum glucose concentration improves to a greater extent than the serum sodium concentration rises, serum effective osmolality will decrease and may precipitate brain edema Miner Electrolyte Metab ; Lever E, Jaspan JB. In other studies, education of primary care providers and school personnel in identifying the signs and symptoms of DKA has been shown to be effective in decreasing the incidence of DKA at the onset of nyperglycemic Patients usually have normal body temperature or mild hypothermia regardless of presence of infection Hyperglycemic Emergencies in Adults.

Finally, patients with diabetes insipidus presenting with severe polyuria and dehydration, who are subsequently treated with free water in a form of intravenous dextrose water, can have hyperglycemia- a clinical picture that can be confused with HHS 98 Table 5.

Abbas E KitabchiM. Acute renal failure ARF caused by rhabdomyolysis due to diabetic hyperosmolar nonketotic coma: Once hypotension improves, the corrected serum sodium level is calculated.

Emerg Med Australas ; DKA can be classified as mild, moderate, or severe based on the severity of metabolic acidosis and the hyperismolar of altered mental status Venous pH should be assessed every 2 hours until the pH rises to 7. Ketosis-prone diabetes–a new subgroup of patients with atypical type 1 and type 2 diabetes? Management of decompensated diabetes.


Intracerebral crises during treatment of diabetic hyperglycdmic. February 6 and 12, The temporal relationship between endogenously secreted stress hormones and metabolic decompensation in diabetic man. Hyperosmolar hyperglycemic state in a patient taking risperidone.

Hyperamylasemia in diabetic ketoacidosis: Effects of acute insulin deficiency on glucose and ketone body turnover in man: Reprints are not available from the author. The emergency management of hyperglycemic-hyperosmolar nonketotic coma in the pediatric patient.

Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS): American Diabetes Association®

Hyperosmolar nature of diabetic coma. Hemodynamic status should be monitored in patients with shock. When the serum glucose level reaches mg per dL Journal of diabetes and its complications ; DKA and HHS remain important causes of morbidity and mortality among diabetic patients despite well-developed diagnostic criteria and treatment protocols 1. Kussmaul respiration, acetone breath, nausea, vomiting and abdominal pain may also occur primarily in DKA and are due to ketosis and acidosis.

Donate today Other Ways to Donate: It is, however, accepted now that true or corrected serum sodium concentration in patients experiencing hyperglycemic crisis should be calculated by adding 2. Our study showed that glucose, bicarbonate, BUN and osmolality, and not pH were significantly different between non-comatose and comatose patients. For information about the SORT evidence rating system, go to https: Acid-base problems in diabetic ketoacidosis.

The administration of insulin without fluid replacement in such patients may further aggravate hypotension Headache is the earliest clinical manifestation of cerebral edema.


Age-Adjusted DKA hospitalization rate per 1, persons with diabetes and in-hospital case-fatality rate, United States, — 4. Management of the hyperosmolar hyperglycemic syndrome. For any urgent enquiries please contact our customer services team who are ready to help with any problems. Evidence-based management of hyperglycemic emergencies in diabetes adx. Fluid resuscitation should be guided by vital signs, urine output, and improvement in sensorium.

Hyperosmolar Hyperglycemic State

Professional Resources Shop Diabetes. HHNS is usually brought on by something else, such as an illness or infection. It is important to point out that the IV use of fast-acting insulin analogs is not recommended for patients with severe DKA hhperosmolar HHS, as there are no studies to support their use. When you are sick, you will check your blood sugar more often, and drink a glass of liquid alcohol-free and hyperglyceimc every hour.

The Memphis diabetes continuing care program. View in own window.

Immediate access to this article. Insulin substitution approach should be very conservative as it is expected that insulin resistance will improve with rehydration. Therefore, inappropriately high or low levels of PCO2, determined by ABG will suggest the presence of a mixed acid-based disorder. Mayo Clin Proc ;