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Difference Between Dka And Hhns

Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Nonketotic Syndrome.

Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Nonketotic Syndrome.

1. Endocrinol Metab Clin North Am. 2000 Dec;29(4):683-705, V. Diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome. (1)Endocrinology-Hypertension Division, Brigham and Women's Hospital, Boston, Massachusetts, USA. Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome(HHNS) are life-threatening acute metabolic complications of diabetes mellitus.Although there are some important differences, the pathophysiology, thepresenting clinical challenge, and the treatment of these metabolic derangements are similar. Each of these complications can be seen in type 1 or type 2diabetes, although DKA is usually seen in patients with type 1 diabetes and HHNS in patients with type 2 disease. The clinical management of these syndromesinvolves careful evaluation and correction of the metabolic and volume status of the patient, identification and treatment of precipitating and comorbidconditions, a smooth transition to a long-term treatment regimen, and a plan toprevent recurrence. Hyperglycemic Hyperosmolar Nonketotic Coma*/diagnosis Hyperglycemic Hyperosmolar Nonketotic Coma*/etiology Hyperglycemic Hyperosmolar Nonketotic Coma*/mortality Hyperglycemic Hyperosmolar Nonketotic Coma*/therapy Continue reading >>

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State

Author: Dipa Avichal, DO; Chief Editor: George T Griffing, MD more... Hyperosmolar hyperglycemic state (HHS) isone of two serious metabolic derangements that occurs in patients with diabetes mellitus (DM). [ 1 ] It is alife-threatening emergency that, although less common than its counterpart, diabetic ketoacidosis (DKA), has a much higher mortality rate, reaching up to 5-10%. (See Epidemiology.) HHS was previously termed hyperosmolar hyperglycemic nonketotic coma (HHNC); however, the terminology was changed because coma is found in fewer than 20% of patients with HHS. [ 2 ] HHS is most commonly seen in patients with type 2DM who have some concomitant illness that leads to reduced fluid intake, as seen, for example, in elderly institutionalizedpersons with decreased thirst perception andreduced ability to drink water. [ 3 ] Infection is the most common preceding illness, but many other conditions, such as stroke or myocardial infarction, can cause this state. [ 3 ] Once HHS has developed, it may be difficult to identify or differentiate it from the antecedent illness. (See Etiology.) HHS is characterized by hyperglycemia, hyperosmolarity, and dehydration without significant ketoacidosis. Most patients present with severe dehydration and focal or global neurologic deficits. [ 2 , 4 , 5 ] The clinical features of HHS and DKA overlap and are observed simultaneously (overlap cases) in up toone thirdof cases. According to the consensus statement published by the American Diabetes Association, diagnostic features of HHS may include the following (see Workup) [ 4 , 6 ] : Plasma glucose level of 600 mg/dL or greater Effective serum osmolality of 320 mOsm/kg or greater Profound dehydration, up to an average of 9L Bicarbonate concentration greater than 15 mEq/L Small ketonuria a Continue reading >>

Diabetic Ketoacidosis And Hyperglycaemic Hyperosmolar State

Diabetic Ketoacidosis And Hyperglycaemic Hyperosmolar State

The hallmark of diabetes is a raised plasma glucose resulting from an absolute or relative lack of insulin action. Untreated, this can lead to two distinct yet overlapping life-threatening emergencies. Near-complete lack of insulin will result in diabetic ketoacidosis, which is therefore more characteristic of type 1 diabetes, whereas partial insulin deficiency will suppress hepatic ketogenesis but not hepatic glucose output, resulting in hyperglycaemia and dehydration, and culminating in the hyperglycaemic hyperosmolar state. Hyperglycaemia is characteristic of diabetic ketoacidosis, particularly in the previously undiagnosed, but it is the acidosis and the associated electrolyte disorders that make this a life-threatening condition. Hyperglycaemia is the dominant feature of the hyperglycaemic hyperosmolar state, causing severe polyuria and fluid loss and leading to cellular dehydration. Progression from uncontrolled diabetes to a metabolic emergency may result from unrecognised diabetes, sometimes aggravated by glucose containing drinks, or metabolic stress due to infection or intercurrent illness and associated with increased levels of counter-regulatory hormones. Since diabetic ketoacidosis and the hyperglycaemic hyperosmolar state have a similar underlying pathophysiology the principles of treatment are similar (but not identical), and the conditions may be considered two extremes of a spectrum of disease, with individual patients often showing aspects of both. Pathogenesis of DKA and HHS Insulin is a powerful anabolic hormone which helps nutrients to enter the cells, where these nutrients can be used either as fuel or as building blocks for cell growth and expansion. The complementary action of insulin is to antagonise the breakdown of fuel stores. Thus, the relea Continue reading >>

Differences Between Hyperosmolar Non-ketotic Hyperglycaemic Coma And Diabetic Ketoacidosis

Differences Between Hyperosmolar Non-ketotic Hyperglycaemic Coma And Diabetic Ketoacidosis

The differences between diabetic ketoacidosis and hyperglycemic non-ketotic hyperosmolar coma are: Diabetic ketoacidosis Non-ketotic hyperosmolar coma Definition Triad of: hyperglycemia, ketonemia and high anion gap acidosis State of hyperosmolality with low or no ketone bodies Cause Excessive synthesis of ketone bodies from free fatty acids Severe hyperglycemia due to insufficient insulin resulting in plasma hyperosmolality and excessive water loss Symptoms Kussmaul respiration, acetone breath, nausea, vomiting, abdominal pain Mental confusion, DehydrationComa Lab Investigations Plasma glucose Serum Urea Serum creatinine Serum ketones Serum electrolytes Plasma Osmolality Urine analysis (ketones) ABG analysis Complete blood count with differentiatials HbA1c Plasma glucose Serum Urea Serum creatinine Serum ketones Serum electrolytes Plasma Osmolality Urine analysis (ketones) ABG analysis Complete blood count with differentiatials HbA1c General Treatment Fluid therapy Insulin therapy Potassium therapy Bicarbonate therapy Fluid therapy Insulin therapy Potassium therapy Continue reading >>

Dka Vs Hhs (hhns) Nclex Review

Dka Vs Hhs (hhns) Nclex Review

Diabetic ketoacidosis vs hyperglycemic hyperosmolar nonketotic syndrome (HHNS or HHS): What are the differences between these two complications of diabetes mellitus? This NCLEX review will simplify the differences between DKA and HHNS and give you a video lecture that easily explains their differences. Many students get these two complications confused due to their similarities, but there are major differences between these two complications. After reviewing this NCLEX review, don’t forget to take the quiz on DKA vs HHNS. Lecture on DKA and HHS DKA vs HHNS Diabetic Ketoacidosis Affects mainly Type 1 diabetics Ketones and Acidosis present Hyperglycemia presents >300 mg/dL Variable osmolality Happens Suddenly Causes: no insulin present in the body or illness/infection Seen in young or undiagnosed diabetics Main problems are hyperglycemia, ketones, and acidosis (blood pH <7.35) Clinical signs/symptoms: Kussmaul breathing, fruity breath, abdominal pain Treatment is the same as in HHNS (fluids, electrolyte replacement, and insulin) Watch potassium levels closely when giving insulin and make sure the level is at least 3.3 before administrating. Hyperglycemic Hyperosmolar Nonketotic Syndrome Affects mainly Type 2 diabetics No ketones or acidosis present EXTREME Hyperglycemia (remember heavy-duty hyperglycemia) >600 mg/dL sometimes four digits High Osmolality (more of an issue in HHNS than DKA) Happens Gradually Causes: mainly illness or infection and there is some insulin present which prevents the breakdown of ketones Seen in older adults due to illness or infection Main problems are dehydration & heavy-duty hyperglycemia and hyperosmolarity (because the glucose is so high it makes the blood very concentrated) More likely to have mental status changes due to severe dehydrat Continue reading >>

Difference Between Dka And Hhnk

Difference Between Dka And Hhnk

Diabetes is a disease that is becoming common among people, and that is because of the food we consume. There are many issues relate to the disease itself that can be harmful to the person that is suffering from it. The two main types of these are known as Diabetic ketoacidosis and as hyperosmolar hyperglycemic nonketoacidosis. The main difference between these two is that the first one takes place at a fast speed and is the one which is less dangerous whereas the other one takes a while to fully takes control of the body and is considered extremely fatal. One of the most common effects for a person who has diabetes. One of the most strange results for a person who has diabetes. Urination several times in a day. Abdominal pain and sometimes even vomiting or nausea. Several times for urination, the sudden urge of drinking water even when you are not thirsty, dehydration. DKA that stands for Diabetic ketoacidosis is one of the most dangerous symptoms for a diabetic person. In this, what happens is that the body of a person suffering from this disease starts to produce a high level of ketones that are known as blood acids and the human body does not need them in an excess amount. This disease mainly occurs when the body of a person is not able to produce enough insulin. This constituent plays a significant role in the maintenance of the blood levels of sugar in the human body and when there is less amount of it produced continuously, other ones, such as ketones start to take over and result in serious harm to the human being. Insulin is one of the major parts of our muscles as glucose from this one strengths the whole body including the muscles and tissues. When it is not there, the body will start using fat instead of glucose and then, the acids such as the ones discusse Continue reading >>

Diabetic Ketoacidosis And Hyperosmolar Hyperglycemic State In Adults: Clinical Features, Evaluation, And Diagnosis

Diabetic Ketoacidosis And Hyperosmolar Hyperglycemic State In Adults: Clinical Features, Evaluation, And Diagnosis

INTRODUCTION 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. 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. The epidemiology, pathogenesis, and treatment of these disorders are discussed separately. DKA in children is also reviewed separately. (See "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis".) Continue reading >>

What Is The Difference Between Hyperglycemia And Hypoglycemia?

What Is The Difference Between Hyperglycemia And Hypoglycemia?

By Debra A. Sokol-McKay, MS, CVRT, CDE, CLVT, OTR/L, SCLV What Is Hyperglycemia? In relation to diabetes, hyperglycemia refers to chronically high blood glucose levels. Most medical professionals define hyperglycemia by using the blood glucose goals that you and your physician have established and combining those goals with the blood glucose target ranges set by the American Diabetes Association. It's important to understand that you'll probably experience high blood glucose levels from time to time, despite your best efforts at control. As with any chronic disease, talk with your physician and diabetes care team if the pattern of your blood glucose readings is consistently higher or lower than your blood glucose goals. Complications from Hyperglycemia Persistent hyperglycemia can cause a wide range of chronic complications that affect almost every system in your body. When large blood vessels are affected, it can lead to: Stroke (cerebral vascular disease) Heart attack or Congestive Heart Failure (coronary heart disease) Circulation disorders and possible amputation (peripheral vascular disease) When smaller blood vessels are affected, it can lead to: Kidney disease (nephropathy) Nerve damage (neuropathy) Diabetic eye disease (retinopathy) Joseph Monks: Writer, Producer, and Film Director Joseph Monks, who has diabetic retinopathy, creates and produces films for his production company Sight Unseen Pictures. He is also the first blind filmmaker to direct a feature film. Says Joe, "I'm not uncomfortable with the term 'blind.' I'm not thrilled about it, of course, but it's accurate. The lights went out for me in early 2002 as a result of diabetic retinopathy—the death of my retinas. It is what it is, so when it happened, I decided that I wasn't going to let it put an en Continue reading >>

Dka/hhns Flashcards | Quizlet

Dka/hhns Flashcards | Quizlet

Characterized by hyperglycemia, ketosis, acidosis, and dehydration Mostly seen in type I diabetics, but can be in type II Precipitating factors: illness, infection, inadequate insulin dosage, undiagnosed type I diabetes, poor self-management, and neglect Circulating supply of insulin is insufficient Ketosis alters pH of blood, causing metabolic acidosis Insulin deficiency impairs protein synthesis, causes protein degradation leads Insulin deficiency also stimulates production of glucose from amino acids In the liver leads to Deficiency of insulin = additional glucose cannot be used leads to Untreated, this leads to severe depletion of Na, K, Cl, Mg, and PO4 Vomiting caused by acidosis can further worsen electrolyte losses Renal failure can cause retention of ketones and glucose, acidosis worsens DEATH IS INEVITABLE IF THIS CONDITION IS NOT TREATED! Poor skin tugor, dry mucous membranes, tachycardia, orthostatic hypotension Abdominal pain - can be accompanied by nausea and vomiting Blood glucose >250mg/dL, pH <7.30, HCO3- <15mEq/L, moderate to large ketones in UA They are acidodic and trying to blow off C02 to compensate. Acidoc and have Ketotsis= keytones in blood and urine. Administration of fluids and electrolytes Typically .45-.9% NS until UOP 30-60ml/hour When blood glucose levels approach 250mg/dL, add D5W to the solution to prevent hypoglycemia Replace extracellular and intracellular water and correct deficits of electrolytes Incorrect fluid replacement can cause a sudden fall in serum Na leads to cerebral edema Monitor for fluid overload in renal / cardiac patients Early K replacement is important - hypokalemia can be life-threatening Initially K will be very high, but will shift back into the cell causing hypokalemia Give fluids until we have adequate urine out Continue reading >>

Hyperglycemic Crises: Diabetic Ketoacidosis (dka), And Hyperglycemic Hyperosmolar State (hhs)

Hyperglycemic Crises: Diabetic Ketoacidosis (dka), And Hyperglycemic Hyperosmolar State (hhs)

Go to: 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. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of DKA and HHS. Critical components of the hyperglycemic crises management include coordinating fluid resuscitation, insulin therapy, and electrolyte replacement along with the continuous patient monitoring using available laboratory tools to predict the resolution of the hyperglycemic crisis. Understanding and prompt awareness of potential of special situations such as DKA or HHS presentation in comatose state, possibility of mixed acid-base disorders obscuring the diagnosis of DKA, and risk of brain edema during the therapy are important to reduce the risks of complications without affecting recovery from hyperglycemic crisis. Identification of factors that precipitated DKA or HHS during the index hospitalization should help prevent subsequent episode of hyperglycemic crisis. For extensive review of all related areas of Endocrinology, visit WWW.ENDOTEXT.ORG. Go to: INTRODUCTION Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) represent two extremes in the spectrum of decompensated diabetes. DKA and HHS remain important causes of morbidity and mortality among diabetic patients despite well developed diagnostic criteria and treatment protocols (1). The annual incidence of DKA from population-based studies is estimated to range from 4 to 8 episodes per 1,000 patient admissions with diabetes (2). The incidence of DKA continues to increase and it accounts for about 140,000 hospitalizations in the US in 2009 (Figure 1 a) (3). Continue reading >>

Difference Between Dka And Hhnk

Difference Between Dka And Hhnk

DKA vs HHNK The body normally functions to control the intake of glucose into the cells. In normal cases, insulin is supplied endogenously in order for the body to get the much needed glucose into the cell and out from the bloodstream, but the normal physiology of the body can be disrupted every once in a while. Because of the diet that people have and their lifestyle, it is common nowadays to see cases of diabetes. Type II Diabetes is the type of diabetes that develops insulin resistance to the cells. There are a number of symptoms that people experience whenever they have a dysfunctional system that pertains to the control of the blood sugar. In type II diabetes, one of the most common signs is uncontrolled weight loss and whenever the person’s blood is taken, there are instances of hyperglycemia. Normally, you would want to get your blood glucose level within 80-120 mg/dl. But because of the fact that resistance is present during type II diabetes – unlike Type I diabetes where production itself is limited – it is expected that the glucose is found in the bloodstream rather than in the cells. Two of the worst complications of diabetes are DKA and HHNK. There are striking disparities between these two diseases when it comes to pathophysiology and other aspects. DKA is called diabetic ketoacidosis and is one of the deadliest complications that one can experience in diabetes. On the other hand, HHNK, which literally means hyperosmolar hyperglycemic non-ketoacidosis or simply non-ketoacidotic coma. The similarity between HHNK and DKA is the fact that both are potenitally life threatening and should be managed as soon as possible. DKA is caused by the shortage of insulin. It happens both in type I and type II diabetes. Whenever the body feels that there is a shortage Continue reading >>

Treatment Of Diabetic Ketoacidosis (dka)/hyperglycemic Hyperosmolar State (hhs): Novel Advances In The Management Of Hyperglycemic Crises (uk Versus Usa)

Treatment Of Diabetic Ketoacidosis (dka)/hyperglycemic Hyperosmolar State (hhs): Novel Advances In The Management Of Hyperglycemic Crises (uk Versus Usa)

Go to: Diabetic Ketoacidosis Prior to the discovery and isolation of insulin in 1922 by Banting and Best, type 1 diabetes was universally fatal within a few months of initial diagnosis. Once mass production was started, the challenge to those early pioneers of insulin treatment was learning how to use this new wonder drug, e.g., how much to give and how often to give it, in order to treat the hyperglycemia without raising the inherent risk of hypoglycemia. In 1945, Howard Root in Boston described how they had improved the outcomes for people with diabetic ketoacidosis (DKA), reducing mortality to 12% by 1940 and to 1.6% by 1945 using high doses of insulin—giving an average of 83 units within the first 3 h of treatment in 1940 and 216 units by 1945 [3]. They described how in 1945, they used an average of 287 units in the first 24 h, but this ranged from 50 to 1770 units [3]. In Birmingham, UK, high-dose insulin was also being used with similar success—doses varying depending on the degree of consciousness, with those unarousable on admission given doses between 500 and 1400 units per 24 h [4]. DKA remains a medical emergency; over time, mortality has continued to fall but remains a significant risk, especially amongst the young, socially isolated and when care provision is fragmented [5•, 6•]. Overall, the diagnosis and treatment of DKA are very similar in the UK and USA with a few differences. The UK has separate guidelines on the management of DKA [7], while the USA has a position statement on DKA and HHS that was updated in 2009 [8]. The UK guideline differs in several ways from the US position statement. The concept of low-dose intravenous insulin was established in the late 1960s and early 1970s by teams on both sides of the Atlantic. The UK championed the u Continue reading >>

Hyperosmolar Non Ketotic Hypergycaemic Coma (honk) - Deranged Physiology

Hyperosmolar Non Ketotic Hypergycaemic Coma (honk) - Deranged Physiology

Hyperosmolar Non Ketotic Hypergycaemic Coma (HONK) Though a distinction is being made between diabetic ketoacidosis and HONK, the two really form a part of the same disease spectrum. Some ketoacidosis is present in HONK, and some hyperosmolarity is present in DKA. However, different mechanisms are at play. HONK is distinct form DKA, and the distinction is not entirely arbitrary, at least from the management point of view. For instance, even though the conditions co-exist 30% of the time, it is possible to treat pure HONK without any supplemental insulin (because there is a satisfactory amount of it in circulation already).DKA is 3 times more common, but HONK has 3 times greater mortality. The chapter on DKA presents a table of discriminating features to help distinguish HONK from DKA. Past CICM SAQs involving HONk have included the following: Question 24 from the first paper of 2017 (management strategy) Question 1 from the second paper of 2016 (DKA vs HONK) Question 17 from the first paper of 2014 (DKA vs HONK) Question 18.1 from the second paper of 2008 (diagnosis and complications) Question 13 from the first paper of 2002 (pathophysiology, complications and treatment) Similarly to DKA, a stress response which mobilises metabolic substrates in a Type 2 diabetic will result in HONK. Precipitating Factors for Hyperosmolar Hyperglycaemia The key distinction between DKA and HONK seems to be the fact that in HONk, there is still enough insulin to overcome the ketogenic effects of glucagon. Glucagon inhibits acetyl-CoA carboxylase, which normally converts acetyl-CoA into malonyl-CoA. Malonyl CoA inhibits acyl-carnitine synthesis; if this is uninhibited, it results in a stream of fatty acids being sucked up into the mitochondria to be converted into ketones. Thus, we have a Continue reading >>

Diabetic Ketoacidosis And Hyperosmolar Hyperglycemic State.

Diabetic Ketoacidosis And Hyperosmolar Hyperglycemic State.

Med Klin (Munich). 2006 Mar 22;101 Suppl 1:100-5. Diabetic ketoacidosis and hyperosmolar hyperglycemic state. Clinic II and Polyclinic for Internal Medicine, University of Cologne, Germany. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the two most serious metabolic complications of diabetes mellitus (DM). These disorders can occur in both type 1 and type 2 DM. DKA is characterized by hyperglycemia, ketone body formation and metabolic acidosis. Precipitating causes are usually infection or insulin omission. Over the past 20 years, there has been no reduction in the DKA mortality rates, which remain between 3.4% and 4.6%. HHS is manifested by marked elevation of blood glucose, hyperosmolality and little or no ketosis. Precipitating causes of HHS are infection, undiagnosed diabetes and substance abuse. The mortality rates of the HHS remain high at approximately 15%. Basic common pathophysiological mechanisms in both conditions, which differ only in the magnitude of dehydration and degree of ketoacidosis, are the reduction in the effective insulin action combined with increased counterregulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). While in DKA the lack of insulin combined with increased catecholamines results in accelerated lipolysis and thus production of excess fatty acids, leading to beta-oxidation and ketogenesis, in HHS residual beta-cell function is adequate to prevent lipolysis but not hyperglycemia. The prognosis of both conditions is substantially worsened in patients > 65 years of age and in the presence of coma and hypotension. Mainstays of therapy are intravenous insulin and fluid replacement as well as the concomitant treatment of the precipitating factors. Improved patient education and implementati Continue reading >>

Acute Complications Of Diabetes - Hyperosmolar Hyperglycemic Nonketotic State

Acute Complications Of Diabetes - Hyperosmolar Hyperglycemic Nonketotic State

- [Voiceover] Diabetes mellitus and its associated complications are the 8th leading cause of death worldwide. Now normally we think of both type 1 and type 2 diabetes as being more chronic conditions that result in complications such as kidney disease and cardiovascular disease over years to decades. And this is true, but there are also a couple of very important acute complications of diabetes mellitus. And these are known as diabetic ketoacidosis, or DKA for short, and hyperosmolar hyperglycemic non-ketotic state, or HHNS for short. And unfortunately these acute complications can be very serious, especially HHNS, which has a mortality rate of eight to 20%. In this video, let's discuss hyperosmolar hyperglycemic non-ketotic state. Now the name hyperosmolar hyperglycemic non-ketotic state is pretty descriptive in regards to the metabolism that underlies the disease. However, it does not really describe the clinical presentation of the condition. So let's start with that. And most commonly, someone with HHNS has already been diagnosed with diabetes, and this occurs sometime after their initial diagnosis. And since they have diabetes, they likely will have hyperglycemia, which is one of the defining characteristics of diabetes mellitus. And as we'll discuss in just a minute, it's this hyperglycemia that's driving a lot of the events that are occurring in HHNS. Now over a period of days to weeks, someone with HHNS is gonna become pretty sick, and they're gonna have symptoms of fatigue, maybe some weight loss. They're gonna have extreme thirst and frequent urination. On physical exam they'll have signs of dehydration, such as a high heart rate, known as tachycardia, a low blood pressure known as hypotension, the mucus membranes in their mouth may be dry, and their skin may Continue reading >>

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