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Nkhs Diabetes

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 >>

Diabetic Ketoacidosis And Hyperosmolar Hyperglycemic State In Adults: Epidemiology And Pathogenesis

Diabetic Ketoacidosis And Hyperosmolar Hyperglycemic State In Adults: Epidemiology And Pathogenesis

INTRODUCTION Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS, also called hyperosmotic hyperglycemic nonketotic state) are two of the most serious acute complications of diabetes. They each represent an extreme in the hyperglycemic spectrum. The epidemiology and the factors responsible for the metabolic abnormalities of DKA and HHS in adults will be discussed here. The clinical features, evaluation, diagnosis, and treatment of these disorders are discussed separately. (See "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis" and "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Treatment".) EPIDEMIOLOGY Diabetic ketoacidosis (DKA) is characteristically associated with type 1 diabetes. It also occurs in type 2 diabetes under conditions of extreme stress such as serious infection, trauma, cardiovascular or other emergencies, and, less often, as a presenting manifestation of type 2 diabetes, a disorder called ketosis-prone diabetes mellitus. (See "Syndromes of ketosis-prone diabetes mellitus".) DKA is more common in young (<65 years) patients, whereas hyperosmolar hyperglycemic state (HHS) most commonly develops in individuals older than 65 years [1,2]. The National Diabetes Surveillance Program of the Centers for Disease Control (CDC) estimated that there were 140,000 hospital discharges for DKA in 2009 in the United States, compared to 80,000 in 1988 (figure 1) [2]. Population-based data are not available for HHS. The rate of hospital admissions for HHS is lower than the rate for DKA, and accounts for less than 1 percent of all primary diabetic admissions [1,3-5]. The mortality rate for hyperglycemic crisis declined between 1980 and 2009 (figure 2) [6]. Mortality in Continue reading >>

Vital Sign Triage To Rule Out Diabetic Ketoacidosis And Non-ketotic Hyperosmolar Syndrome In Hyperglycemic Patients

Vital Sign Triage To Rule Out Diabetic Ketoacidosis And Non-ketotic Hyperosmolar Syndrome In Hyperglycemic Patients

Abstract To develop a prediction algorithm to rule out diabetic ketoacidosis (DKA) and non-ketotic hyperosmolar syndrome (NKHS) based on vital signs for early triage of patients with diabetes. The subjects were consecutive adult diabetic patients with hyperglycemia (blood glucose >or=250mg/dl) who presented at an emergency department. Based on a derivation sample (n=392, 70% of 544 patients at a hospital in Okinawa), recursive partitioning analysis was used to develop a tree-based algorithm. Validation was conducted using the other 30% of the patients in Okinawa (n=152, internal validation) and patients at a hospital in Tokyo (n=95, external validation). Three risk groups for DKA/NKHS were identified: a high-risk group of patients with glucose >400mg/dl or systolic blood pressure <100mmHg; a low risk group of patients with glucose or=100mmHg, pulse Continue reading >>

Hyperosmolar Hyperglycemic State (hhs)

Hyperosmolar Hyperglycemic State (hhs)

(Nonketotic Hyperosmolar Syndrome; Nonketotic Hyperosmolar Coma) By Erika F. Brutsaert, MD, Assistant Professor, Albert Einstein College of Medicine; Attending Physician, Montefiore Medical Center Hyperosmolar hyperglycemic state is a complication of diabetes mellitus that most often occurs in type 2 diabetes. Symptoms of hyperosmolar hyperglycemic state include extreme dehydration and confusion. Hyperosmolar hyperglycemic state is diagnosed by blood tests that show very high levels of glucose and very concentrated blood. Treatment is intravenous fluids and insulin. Complications include coma, seizures, and death. There are two types of diabetes mellitus , type 1 and type 2. In type 1 diabetes, the body produces almost no insulin, a hormone produced by the pancreas that helps sugar (glucose) move from the blood into the cells. In type 2 diabetes, the body produces insulin, but cells fail to respond normally to the insulin. In both types of diabetes. the amount of sugar (glucose) in the blood is elevated. If people with type 1 diabetes receive no insulin, or they need more insulin because of an illness, fat cells begin breaking down to provide energy. Fat cells that break down produce substances called ketones. Ketones provide some energy to cells but also make the blood too acidic (ketoacidosis). Diabetic ketoacidosis is a dangerous, sometimes life-threatening, disorder. Because people with type 2 diabetes produce some insulin, ketoacidosis does not usually develop even when type 2 diabetes is untreated for a long time. However, with hyperosmolar hyperglycemic state, the blood glucose levels can become extremely high (even exceeding 1,000 mg per deciliter of blood). Such very high blood glucose levels cause the person to pass large amounts of urine, which eventually ca Continue reading >>

Surgery 2: Diabetes Flashcards | Quizlet

Surgery 2: Diabetes Flashcards | Quizlet

Initially, insulin resistance. Then, beta-cell failure Obesity, ethnicity, race, strong FH, gestational DM 15-20% of Type 2's may really be Type 1.5 Serrendipitous finding back in the '70's (surprise finding) include diminution of symptoms, achieving metabolic control, preventing complications. controls BW and allows insulin to work better. includes joining the ADA, nutrition, diet control, self foot monitoring. Insulin therapy in type 2 DM is indicated when oral agents fail, DKA, NKHS, newly dx'ed with severe hyperglycemia, or situations (i.e. pregnancy) in which p.o. may be contraindicated include tachycardia, GI distress, polyuria, polydipsia, N+V, Kussmaul respiration, fruity breath, dehydration, shock, and coma include metabolic acidosis, positive serum ketones, hyperglycemia, hyponatremia, hyperkalemia, azotemia, elevated amylase and transaminases. includes ICU. Fluids trump all, followed by insulin, then electrolytes 1 L quickly, then 1 L/hr. may require 12-24 hr fluid replacement. Look at BP, ins&outs, clinical improvement to decide when to stop So 70kg person needs 10 units bolus right away K deficit should be assumed or anticipated bc insulin therapy shifts K into intracellular compartment = results in hypokalemia Treat by adding 10-40miliequivalents/hr of K to IV include lactic acidosis, arterial thrombosis, cerebral edema, rebound DKA Nonketotic Hyperosmolar Syndrome (NKHS) precipitating factors factors include noncompliance, stroke, stress, diet, drug or -OH use. Nonketotic Hyperosmolar Syndrome (NKHS) clinical findings include dehydration, insidious, deterioration, alterations in consciousness, focal neuro deficits. Nonketotic Hyperosmolar Syndrome (NKHS) lab findings include absence of ketonemia, hypergylcemia, Ph greater than 7.3; lactic acidosis can de 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 >>

Hyperosmolar Hyperglycemic State (hhs)

Hyperosmolar Hyperglycemic State (hhs)

By Erika F. Brutsaert, MD, Assistant Professor, Albert Einstein College of Medicine; Attending Physician, Montefiore Medical Center Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus (DM) characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. It most often occurs in type 2 DM, often in the setting of physiologic stress. HHS is diagnosed by severe hyperglycemia and plasma hyperosmolality and absence of significant ketosis. Treatment is IV saline solution and insulin. Complications include coma, seizures, and death. Hyperosmolar hyperglycemic state (HHSpreviously referred to as hyperglycemic hyperosmolar nonketotic coma [HHNK] and nonketotic hyperosmolar syndrome) is a complication of type 2 diabetes mellitus and has an estimated mortality rate of up to20%, which is significantly higher than the mortality for diabetic ketoacidosis (currently < 1%). It usually develops after a period of symptomatic hyperglycemia in which fluid intake is inadequate to prevent extreme dehydration due to the hyperglycemia-induced osmotic diuresis. Acute infections and other medical conditions Drugs that impair glucose tolerance (glucocorticoids) or increase fluid loss (diuretics) Serum ketones are not present because the amounts of insulin present in most patients with type 2 DM are adequate to suppress ketogenesis. Because symptoms of acidosis are not present, most patients endure a significantly longer period of osmotic dehydration before presentation, and thus plasma glucose (> 600 mg/dL [> 33.3 mmol/L]) and osmolality (> 320 mOsm/L) are typically much higher than in diabetic ketoacidosis (DKA). The primary symptom of HHS is altered consciousness varying from confusion or disorientation to coma, usually as Continue reading >>

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State

A serious metabolic complication of diabetes characterized by severe hyperglycemia, hyperosmolality, and volume depletion, in the absence of severe ketoacidosis. Occurs most commonly in older patients with type 2 diabetes. Contributes to less than 1% of all diabetes-related admissions. However, mortality is high (5% to 15%). Presents with polyuria, polydipsia, weakness, weight loss, tachycardia, dry mucus membranes, poor skin turgor, hypotension, and, in severe cases, shock. Altered sensorium (lethargy, disorientation, stupor) is common and correlates best with effective serum osmolality. Coma is rare and, if seen, is usually associated with a serum osmolality >340 mOsm/kg. Treatment includes correction of fluid deficit and electrolyte abnormalities, and IV insulin. Hyperosmolar hyperglycemic syndrome (HHS), also known as non-ketotic hyperglycemic hyperosmolar syndrome (NKHS), is characterized by profound hyperglycemia (glucose >600 mg/dL), hyperosmolality (effective serum osmolality 320 mOsm/kg), and volume depletion in the absence of significant ketoacidosis (pH >7.3 and HCO3 >15 mEq/L), and is a serious complication of diabetes. HHS may be the first presentation of type 2 diabetes. [1] Kitabchi AE, Umpierrez GE, Murphy MB, et al. Management of hyperglycemic crises in patients with diabetes. Diabetes Care. 2001;24:131-153. [2] Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32:1335-1343. Although both HHS and diabetic ketoacidosis (DKA) are often discussed as distinct entities, they represent 2 points on the spectrum of metabolic derangements in diabetes, [3] Bhattacharyya OK, Estey EA, Cheng AY. Update on the Canadian Diabetes Association 2008 clinical practice guidelines. Can Fam Physician. 2009; 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 >>

Medical Dictionary For Regulatory Activities - Hyperglycaemia/new Onset Diabetes Mellitus (smq) - Classes | Ncbo Bioportal

Medical Dictionary For Regulatory Activities - Hyperglycaemia/new Onset Diabetes Mellitus (smq) - Classes | Ncbo Bioportal

Medical Dictionary for Regulatory Activities Hyperglycaemia/new onset diabetes mellitus (SMQ) Hyperglycemia/new onset diabetes mellitus (SMQ) Diagnosis based on elevated levels of fasting plasma glucose or random plasma glucose plus symptoms. Hyperglycemia in diabetes mellitus (DM) occurs as a result of reduced insulin secretion, decreased glucose usage, or increased glucose production. Type I DM: About 10% of all cases; Insulin deficiency resulting from autoimmune beta cell destruction (type IA) or idiopathic (type IB). Type II DM: About 90% of all cases; Heterogeneous disorder of glucose metabolism characterized by variable degrees of insulin resistance, impaired insulin secretion, and increased hepatic glucose production. Drugs have been associated with hyperglycemia that can progress to new onset DM: Can mimic type I or II; Mechanisms: Diminished insulin production, inhibited insulin secretion, and reduced beta cell volume (e.g., cyclosporine); Autoimmune destruction of beta cells and increased insulin antibody titers (e.g., interleukin-2); Hormone stimulated gluconeogenesis and decreased insulin sensitivity (e.g., glucocorticosteroids); Decreased insulin sensitivity (e.g. protease inhibitors); Often reversible by discontinuation of drug, or can be controlled with oral antidiabetic agents and/or insulin. Common findings/symptoms: polydipsia, polyphagia, polyuria, weight loss, hypercholesterolemia, and hypertriglyceridemia. Acute complications: Diabetic ketoacidosis (DKA) particularly type I; Nonketotic hyperosmolar state (NKHS) particularly type II diabetes; Both can result in neurologic symptoms including coma. Long term complications are microvascular (e.g., retinopathy), macrovascular (e.g., coronary artery disease), neuropathic (e.g., paresthesias). Hyperglycem Continue reading >>

What Is Nonketotic Hyperosmolar Diabetes?

What Is Nonketotic Hyperosmolar Diabetes?

What Is Nonketotic Hyperosmolar Diabetes? What Is Nonketotic Hyperosmolar Diabetes? NKHS occurs when blood sugar rises to very high levels and the body uses urination to try to get rid of the excess glucose, eventually leading to extreme dehydration. NKHS is usually brought on by illness or injury and is characterized by a blood sugar over 600 mg/dL. Without proper treatment, the extreme dehydration will lead to seizures, coma and possibly death. Due to a mortality rate of over 40%, it is critical for people to contact their diabetes team as soon as possible if they experience symptoms. The symptoms of NKHS are frequent urination followed by a decreased amount of urine that looks very dark, extreme thirst, no ketones, blood sugar over 600 mg/dL, warm skin that does not sweat, fever over 101 degrees, sleepiness, confusion, hallucinations and weakness on one side of the body. NKHS is treated with an IV saline solution to rehydrate the body, as well as insulin to lower the blood sugar. Continue reading >>

Type 2 Diabetes Mellitus With Hyperosmolarity Without Nonketotic Hyperglycemic-hyperosmolar Coma (nkhhc)

Type 2 Diabetes Mellitus With Hyperosmolarity Without Nonketotic Hyperglycemic-hyperosmolar Coma (nkhhc)

E11.00 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Short description: Type 2 diab w hyprosm w/o nonket hyprgly-hypros coma (NKHHC) This is the American ICD-10-CM version of E11.00 - other international versions of ICD-10 E11.00 may differ. Approximate Synonyms Diabetes type 2 with hyperosmolarity Hyperosmolarity without nonketotic hyperglycemic hyperosmolar coma due to type 2 diabetes mellitus ICD-10-CM E11.00 is grouped within Diagnostic Related Group(s) (MS-DRG v35.0): Code History 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM) 2017 (effective 10/1/2016): No change 2018 (effective 10/1/2017): No change Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. Continue reading >>

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State

Hyperosmolar hyperglycemic state (HHS) is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis.[4] Symptoms include signs of dehydration, weakness, legs cramps, trouble seeing, and an altered level of consciousness.[2] Onset is typically over days to weeks.[3] Complications may include seizures, disseminated intravascular coagulopathy, mesenteric artery occlusion, or rhabdomyolysis.[2] The main risk factor is a history of diabetes mellitus type 2.[4] Occasionally it may occur in those without a prior history of diabetes or those with diabetes mellitus type 1.[3][4] Triggers include infections, stroke, trauma, certain medications, and heart attacks.[4] Diagnosis is based on blood tests finding a blood sugar greater than 30 mmol/L (600 mg/dL), osmolarity greater than 320 mOsm/kg, and a pH above 7.3.[2][3] Initial treatment generally consists of intravenous fluids to manage dehydration, intravenous insulin in those with significant ketones, low molecular weight heparin to decrease the risk of blood clotting, and antibiotics among those in whom there is concerns of infection.[3] The goal is a slow decline in blood sugar levels.[3] Potassium replacement is often required as the metabolic problems are corrected.[3] Efforts to prevent diabetic foot ulcers are also important.[3] It typically takes a few days for the person to return to baseline.[3] While the exact frequency of the condition is unknown, it is relatively common.[2][4] Older people are most commonly affected.[4] The risk of death among those affected is about 15%.[4] It was first described in the 1880s.[4] Signs and symptoms[edit] Symptoms of high blood sugar including increased thirst (polydipsia), increased volume of urination (polyurea), and i Continue reading >>

Nonketotic Hyperosmolar Syndrome

Nonketotic Hyperosmolar Syndrome

Nonketotic hyperosmolar syndrome (NKHS) consists of hyperglycemia,hyperosmolarity, severe dehydration and altered mental status without significantketosis or acidosis. NKHS typically occurs in the elderly type II diabetic; although about half of thepatients have no known prior history of diabetes. It may also occur in children (rare)and no diabetics in special circumstances. The classic scenario is that of an elderly,type II diabetic who encounters a stressful event. As with DKA, the underlying mechanism of NKHS is a relative insulin deficiency inthe setting of elevated stress/counter regulatory hormones. In contrast to DKA, insulinlevels are sufficient to prevent significant ketoacidosis. The result is severe hyperglycemia,osmotic diuresis, profound dehydration, and electrolyte depletion. The mortality rate of NKHS is higher than that of DKA. This can be explained bythree reasons: more profound dehydration and electrolyte disturbances, life-threatening precipitants and coexisting disease are more common. Coma and death are the end-result when left untreated. Infection (most common; usually Gram-negative pneumonia or sepsis) Medications (-blockers, phenytoin, steroids, thiazide diuretics) Peritoneal dialysis, hyper alimentation (may precipitate NKHS in no diabetics) Common Contributing Factors/Coexistent Disease Renal insufficiency (impaired elimination of glucose) Cardiac disease (CHF, A-fib, unstable angina or previous MI) Altered mental status/Altered thirst mechanism (Alzheimers, CVA; unable to keep upwith fluid losses) Physical debilitation (unable to reach water) Diuretic medication (exacerbates fluid losses and thiazides promote hyperglycemia) There are four basic diagnostic criteria: marked hyperglycemia (>600 mg/dl, often>1000 mg/dl); pH >7.3 (may be more acid Continue reading >>

Vital Sign Triage To Rule Out Diabetic Ketoacidosis And Non-ketotic Hyperosmolar Syndrome In Hyperglycemic Patients.

Vital Sign Triage To Rule Out Diabetic Ketoacidosis And Non-ketotic Hyperosmolar Syndrome In Hyperglycemic Patients.

Abstract AIMS: To develop a prediction algorithm to rule out diabetic ketoacidosis (DKA) and non-ketotic hyperosmolar syndrome (NKHS) based on vital signs for early triage of patients with diabetes. METHODS: The subjects were consecutive adult diabetic patients with hyperglycemia (blood glucose >or=250mg/dl) who presented at an emergency department. Based on a derivation sample (n=392, 70% of 544 patients at a hospital in Okinawa), recursive partitioning analysis was used to develop a tree-based algorithm. Validation was conducted using the other 30% of the patients in Okinawa (n=152, internal validation) and patients at a hospital in Tokyo (n=95, external validation). RESULTS: Three risk groups for DKA/NKHS were identified: a high-risk group of patients with glucose >400mg/dl or systolic blood pressure <100mmHg; a low risk group of patients with glucose or=100mmHg, pulse Continue reading >>

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