What is hyperglycemia hyperosmolar syndrome?
Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of type 2 diabetes. It involves extremely high blood sugar (glucose) level without the presence of ketones.
What is the main difference between DKA and HHS?
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.
What causes hyperglycemic hyperosmolar syndrome?
Hyperosmolar hyperglycemic syndrome (HHS) is a clinical condition that arises from a complication of diabetes mellitus. Type 2 diabetes accounts for about 90% to 95% of diabetes cases. It is most commonly seen in patients with obesity.
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 are the components of HHS?
Hyperosmolar hyperglycemic state (HHS) is a metabolic complication of diabetes mellitus characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness.
What is the treatment for HHS?
Treatment. Treatment of HHS requires a four-pronged approach: (1) vigorous intravenous rehydration, (2) electrolyte management, (3) intravenous insulin, and (4) diagnosis and management of precipitating and coexisting problems.
How do you diagnose 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.
How do you calculate HHS?
Osmolarity can be approximately calculated as: plasma osmolarity = 2 (Na mmol/L + K mmol/L) + urea mmol/L + glucose mmol/L. Renal function tests and electrolytes: dehydration and pre-renal acute kidney injury. Sodium and potassium levels are deranged.
What are the signs and symptoms of HHS?
What are the symptoms of hyperosmolar hyperglycemic syndrome (HHS)?
- High blood sugar level (over 600 mg/dL).
- Confusion, hallucinations, drowsiness or passing out.
- Dry mouth and extreme thirst that may eventually get better.
- Frequent urination.
- Fever over 100.4 degrees Fahrenheit.
- Blurred vision or loss of vision.
Why does HHS cause dehydration?
Such very high blood glucose levels cause the person to pass large amounts of urine, which eventually causes severe dehydration. Vomiting, diarrhea, excessive sweating, burns, kidney failure, and use of diuretics may cause dehydration.
What causes death in HHS?
Cerebral edema
Brain cells, which trap osmotically active particles, preferentially absorb water and swell during rapid rehydration. Cerebral edema follows, and, given the constraints of the cranium, uncal herniation may be the cause of death in persons with HHS.
What type of insulin is used for HHS?
Class Summary. Although many patients with hyperosmolar hyperglycemic state (HHS) respond to fluids alone, intravenous (IV) insulin in dosages similar to those used in diabetic ketoacidosis (DKA) can facilitate correction of hyperglycemia.
Which fluid is best for hyperglycemia?
The initial fluid of choice is isotonic saline (0.9% NaCl), even in HHS patients or DKA patients with marked hypertonicity, particularly in patients with evidence of severe sodium deficits manifested by hypotension, tachycardia, and oliguria.
Why is potassium low in HHS?
DKA/HHS patients have both potassium and phosphate deficits, even though most present with normal to high serum levels. The potassium deficit is a result of osmotic diuresis, insulin deficiency, and possibly gastrointestinal losses. Acidosis does not play a major role in the elevated serum potassium level seen in DKA.
What are the complications of HHS?
A serious complication of diabetes mellitus, hyperosmolar hyperglycemic syndrome (HHS) happens when blood sugar levels are very high for a long period of time.
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What are the complications associated with hyperosmolar hyperglycemic syndrome (HHS)?
- Seizures.
- Coma.
- Swelling of the brain.
- Organ failure.
- Death.
What are the 3 main types of IV fluids?
There are three types of IV fluids:
- Isotonic.
- Hypotonic.
- Hypertonic.
Which electrolyte is most affected by hyperglycemia?
During this time both hyperglycemia and hyperosmolarity drive a fluid shift that leads to intracellular dehydration and loss of electrolytes. The two most significant electrolytes depleted are sodium and potassium.
Can ketones be present in HHS?
HHS is a potentially life-threatening emergency
Ketones develop when the blood glucose level is high due to lack of insulin which is needed to allow glucose to enter the cells for energy. Because people with Type 2 diabetes may still be producing some insulin, ketones may not be created.
Which IV fluid is best for hypertension?
3. All these data above suggest that for patients with hypertension, normal saline should be used carefully for intravenous infusion in the treatment of other diseases.
What is in Ringer’s lactate?
The contents of Ringer’s lactate include sodium, chloride, potassium, calcium, and lactate in the form of sodium lactate, mixed into a solution with an osmolarity of 273 mOsm/L and pH of about 6.5. In comparison, normal saline (NS) has an osmolarity of about 286 mOsm/L.
Which IV fluid is best for hyperglycemia?
Normal saline (0.9% sodium chloride) is the most commonly used intravenous fluid in treating DKA, but it has a very high concentration of chloride and can lead to additional acid production when given in large volumes.
Can we give RL in hypertension?
Uses of RL Products
Ramipril is used in the treatment of Hypertension (high blood pressure), prevention of heart attack and stroke and Heart failure.
When is RL used?
RL Infusion is used to provide your body with extra water and electrolytes (salt). It is used when a patient is not able to drink enough liquids or when additional fluids are needed after any surgery or trauma.
Why is it called Ringer’s lactate?
Ringer’s Solutions. Ringer’s solutions are either called lactated or acetated Ringer’s solutions, named for a British physiologist, or Hartmann’s solution, named for a U.S. pediatrician who in the 1930s added lactate as a buffer to prevent acidosis in septic children.
What is difference between Ringer and Ringer lactate?
As a side note, lactated Ringer’s is also slightly different from what’s called simply Ringer’s solution. Ringer’s solution usually has sodium bicarbonate instead of sodium lactate in it. Sometimes Ringer’s solution also has more glucose (sugar) in it than lactated Ringer’s.