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What Is Hyperglycemic Hyperosmolar Syndrome?

Diabetic Hyperosmolar Syndrome

Diabetic Hyperosmolar Syndrome

Print Overview Diabetic hyperosmolar (hi-pur-oz-MOE-lur) syndrome is a serious condition caused by extremely high blood sugar levels. The condition most commonly occurs in people with type 2 diabetes. It's often triggered by illness or infection. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing it into your urine. Left untreated, diabetic hyperosmolar syndrome can lead to life-threatening dehydration. Prompt medical care is essential. Symptoms Diabetic hyperosmolar syndrome can take days or weeks to develop. Possible signs and symptoms include: Blood sugar level of 600 milligrams per deciliter (mg/dL) or 33.3 millimoles per liter (mmol/L) or higher Excessive thirst Dry mouth Increased urination Warm, dry skin Fever Drowsiness, confusion Hallucinations Vision loss Convulsions Coma When to see a doctor Consult your doctor if your blood sugar is persistently higher than the target range your doctor recommends, or if you have signs or symptoms of diabetic hyperosmolar syndrome, such as: Excessive thirst Increased urination Warm, dry skin Dry mouth Fever Seek emergency care if: Your blood sugar level is 400 mg/dL (22.2 mmol/L) or higher and doesn't improve despite following your doctor's instructions for treatment. Don't wait until your blood sugar is high enough to cause diabetic hyperosmolar syndrome. You have confusion, vision changes or other signs of dehydration. Causes Diabetic hyperosmolar syndrome may be triggered by: Illness or infection Not following a diabetes treatment plan or having an inadequate treatment plan Certain medications, such as water pills (diuretics) Sometimes undiagnosed diabetes results in diabetic hyperosmolar syndrome. Risk factors Your risk of developing diabetic hyperosmolar synd Continue reading >>

Hyperglycemic Hyperosmolar Syndrome At The Onset Of Type 2 Diabetes Mellitus In An Adolescent Male

Hyperglycemic Hyperosmolar Syndrome At The Onset Of Type 2 Diabetes Mellitus In An Adolescent Male

Go to: CASE PRESENTATION A 15-year-old African American male was brought to the emergency department by ambulance in an obtunded state. The patient presented with a two-day history of vomiting, diarrhea, abdominal pain, general malaise and emotional distress. Before presentation, the patient experienced a recent history of polyuria and polydipsia of unknown duration. The patient did not have a primary care physician and this was his initial presentation to medical care. On arrival in the emergency room, the patient had a Glasgow Coma Scale score of 9. On examination, the patient was obese, with a body mass index (BMI) of 33 kg/m2. His blood pressure was 112/57 mmHg, with a heart rate of 146 beats/min (normal 60 beats/min to 100 beats/min), a respiratory rate of 60 breaths/min (normal 12 breaths/min to 16 breaths/min) with Kussmaul respirations and a temperature of 38.4°C. The patient’s pupillary response was sluggish and the patient was noted to have dry mucous membranes. Skin examination of the patient revealed acanthosis nigricans along the nape of his neck. The patient’s abdomen was slightly distended but soft. Initial laboratory investigations confirmed a diagnosis of diabetes (Table 1). Of note, the patient’s blood glucose level was markedly elevated at 90.9 mmol/L (normal 3.4 mmol/L to 6.3 mmol/L), serum osmolality 454 mOsm/kg (normal 275 mOsm/kg to 295 mOsm/kg), pH 6.97 (normal 7.35 to 7.41), PCO2 23 mmHg (normal 38 mmHg to 50 mmHg), HCO3−5 mEq/L (normal 20 mEq/L to 25 mEq/L), Na+ 141 mEq/L (normal 135 mEq/L to 145 mEq/L with ‘corrected’ Na+ for hyperglycemia 165 mEq/L), K+ 8.4 mEq/L (normal 3.5 mEq/L to 5.0 mEq/L), and 1+ urine ketones. Hemoglobin A1C was elevated at 13.4% (normal 4.0% to 6.0%), indicating longstanding hyperglycemia. Other than some Continue reading >>

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State

Epidemiology The precise prevalence and incidence of hyperosmolar hyperglycemic syndrome (HHS) is difficult to determine because of the lack of population-based studies and the multiple comorbidities often found in these patients. However, the overall prevalence is estimated at less than 1% of all diabetes-related hospital admissions. [9] [10] Incidence of HHS has been estimated at a rate of 17.5 per 100,000 patient years. [6] HHS is seen most commonly in older patients and those of African-American ethnicity with diabetes. [10] Mortality rates in HHS have been reported to be 5% to 20%, a rate that is 10-fold higher than that reported for diabetic ketoacidosis. [2] [11] Mortality increases significantly above the age of 70 years. [12] A combined state of severe hyperglycemia, hyperosmolality, and metabolic acidosis is seen in approximately 25% of all hyperglycemic emergencies. [5] [13] [14] Continue reading >>

Diabetic Hyperglycemic Hyperosmolar Syndrome

Diabetic Hyperglycemic Hyperosmolar Syndrome

HHS; Hyperglycemic hyperosmolar coma; Nonketotic hyperglycemic hyperosmolar coma (NKHHC); Hyperosmolar nonketotic coma (HONK); Hyperglycemic hyperosmolar non-ketotic state; Diabetes - hyperosmolar 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. Causes HHS is a condition of: Buildup of ketones in the body (ketoacidosis) may also occur. But it is unusual and is often mild compared with diabetic ketoacidosis. HHS is more often seen in people with type 2 diabetes who don't have their diabetes under control. It may also occur in those who have not been diagnosed with diabetes. The condition may be brought on by: Infection Other illness, such as heart attack or stroke Medicines that decrease the effect of insulin in the body Medicines or conditions that increase fluid loss Normally, the kidneys try to make up for a high glucose level in the blood by allowing the extra glucose to leave the body in the urine. But this also causes the body to lose water. If you do not drink enough water, or you drink fluids that contain sugar and keep eating foods with carbohydrates, the kidneys may become overwhelmed. When this occurs, they are no longer able to get rid of the extra glucose. As a result, the glucose level in your blood can become very high. The loss of water also makes the blood more concentrated than normal. This is called hyperosmolarity. It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances. This draws the water out of the body's other organs, including the brain. Risk factors include: Impaired thirst Older age Poor kidney function Poor management of diabetes, not following the treatment plan Continue reading >>

Management Of Decompensated Diabetes. Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome.

Management Of Decompensated Diabetes. Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome.

Abstract DKA and HHS represent two extremes in the spectrum of decompensated diabetes mellitus. Their pathogenesis is related to absolute or relative deficiency in insulin levels and elevations in insulin counterregulatory hormones that lead to altered metabolism of carbohydrate, protein, and fat and varying degrees of osmotic diuresis and dehydration, ketosis, and acidosis. In DKA, insulin deficiency and ketoacidosis are the prominent features of the clinical presentation, and insulin therapy is the cornerstone of therapy. In HHS, hyperglycemia, osmotic diuresis, and dehydration are the prominent features, and fluid replacement is the cornerstone of therapy. As many as one-third of patients may have mixed features of both DKA and HHS. Because the three-pronged approach to therapy for either DKA or HHS consists of fluid administration, intravenous insulin infusion, and electrolyte replacement, mixed cases are managed using the same approach. The therapeutic regimen is tailored according to the prominent clinical features present. In adult patients with mixed features, fluids may be administered more rapidly than they would be in younger patients, or in patients with DKA alone, because the risk for fatal cerebral edema in adults is low and the consequences of undertreatment include vascular occlusion and increased mortality. In younger patients with mixed features, rapid correction of metabolic abnormalities and, consequently, of hyperosmolarity by administration of hypotonic fluids and insulin should be avoided to decrease the risk for precipitating cerebral edema. In addition, if ketoacidosis has been a prominent feature in a mixed case, the patient may have type 1 diabetes with no residual pancreatic islet beta cell secretion and may subsequently need ongoing, life-lo Continue reading >>

Hyperosmolar Hyperglycemic State: A Historic Review Of The Clinical Presentation, Diagnosis, And Treatment

Hyperosmolar Hyperglycemic State: A Historic Review Of The Clinical Presentation, Diagnosis, And Treatment

The hyperosmolar hyperglycemic state (HHS) is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. von Frerichs and Dreschfeld described the first cases of HHS in the 1880s in patients with an “unusual diabetic coma” characterized by severe hyperglycemia and glycosuria in the absence of Kussmaul breathing, with a fruity breath odor or positive acetone test in the urine. Current diagnostic HHS criteria include a plasma glucose level >600 mg/dL and increased effective plasma osmolality >320 mOsm/kg in the absence of ketoacidosis. The incidence of HHS is estimated to be <1% of hospital admissions of patients with diabetes. The reported mortality is between 10 and 20%, which is about 10 times higher than the mortality rate in patients with diabetic ketoacidosis (DKA). Despite the severity of this condition, no prospective, randomized studies have determined best treatment strategies in patients with HHS, and its management has largely been extrapolated from studies of patients with DKA. There are many unresolved questions that need to be addressed in prospective clinical trials regarding the pathogenesis and treatment of pediatric and adult patients with HHS. The hyperosmolar hyperglycemic state (HHS) is a syndrome characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis. The exact incidence of HHS is not known, but it is estimated to account for <1% of hospital admissions in patients with diabetes (1). Most cases of HHS are seen in elderly patients with type 2 diabetes; however, it has also been reported in children and young adults (2). The overall mortality rate is estimated to be as high as 20%, which is about 10 times higher than the mortality in patients with diabetic ketoacidosis (DKA) (3 Continue reading >>

Hyperglycemic

Hyperglycemic

(redirected from hyperglycemic hyperosmolar nonketotic coma (HHNK)) Also found in: Dictionary. hyperglycemic [hi″per-gli-se´mik] 1. characterized by or causing hyperglycemia. 2. an agent that has this effect. hyperglycemic hyperosmolar nonketotic (HHNK) coma a metabolic derangement in which there is an abnormally high serum glucose level without ketoacidosis. 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 in steroid therapy, or acute stress conditions, such as infection. It also may develop during total parenteral nutrition, hemodialysis, or peritoneal dialysis. Called also hyperosmolar nonketotic coma. Symptoms. The hyperglycemia of HHNK coma is usually extreme, with fasting blood sugar levels ranging from 600 to 3000 mg per 100 ml of blood. In contrast to typical diabetic coma, however, the serum acetone level is normal or only slightly elevated. This occurs because, although there is sufficient insulin available to avoid ketosis, there is not enough to metabolize the glucose and thereby relieve the hyperglycemia. Hyperosmolality, resulting from the extremely high concentration of sugar in the blood, causes a shift of water from the intracellular fluid (the less concentrated solution) into the blood (the higher concentrated solution). This results in cellular dehydration. Another symptom of HHNK coma, polyuria, occurs because the high plasma osmolality prevents the normal osmotic return of water to the blood by the renal tubules, and it is excreted in the urine. This leads to a decreased blood volume, which severely hampers the kidney's excretion of glucose and a vicious Continue reading >>

Diabetic Hyperglycemic Hyperosmolar Syndrome

Diabetic Hyperglycemic Hyperosmolar Syndrome

HHS is a condition of: Extremely high blood sugar (glucose) level Decreased alertness or consciousness (in many cases) Buildup of ketones in the body (ketoacidosis) may also occur. But it is unusual and is often mild compared with diabetic ketoacidosis. HHS is more often seen in people with type 2 diabetes who don't have their diabetes under control. It may also occur in those who have not been diagnosed with diabetes. The condition may be brought on by: Infection Other illness, such as heart attack or stroke Medicines that decrease the effect of insulin in the body Medicines or conditions that increase fluid loss Normally, the kidneys try to make up for a high glucose level in the blood by allowing the extra glucose to leave the body in the urine. But this also causes the body to lose water. If you do not drink enough water, or you drink fluids that contain sugar and keep eating foods with carbohydrates, the kidneys may become overwhelmed. When this occurs, they are no longer able to get rid of the extra glucose. As a result, the glucose level in your blood can become very high. The loss of water also makes the blood more concentrated than normal. This is called hyperosmolarity. It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances. This draws the water out of the body's other organs, including the brain. Risk factors include: Impaired thirst Limited access to water (especially in people with dementia or who are bedbound) Older age Poor kidney function Poor management of diabetes, not following the treatment plan as directed Stopping insulin or other medicines that lower glucose level Continue reading >>

Hyperosmolar Non-ketotic Hyperglycaemia

Hyperosmolar Non-ketotic Hyperglycaemia

hyperglycemic hyperosmolar state (HHS) Hperglycemic hyperosmolar state (HHS) previously known as hyperosmolar nonketotic (HONK) coma is a syndrome characterized by extreme elevations in serum glucose concentrations, hyperosmolality and dehydration without significant ketosis (1,2). characteristic features that differentiate it from other hyperglycaemic states such as DKA are: hypovolaemia marked hyperglycaemia (30 mmol/L or more) without significant hyperketonaemia (7.3, bicarbonate >15 mmol/L) osmolality usually 320 mosmol/kg or more N.B. - a mixed picture of HHS and DKA may occur (2) Incidence of HHS is unknown but is thought to be <1% of hospital admissions in patients with diabetes it is common in elderly patients with type 2 diabetes, but HHS has also been reported in children (in infants, especially those with 6q24-related transient neonatal diabetes mellitus ) young adults in type 1 diabetes subjects in children it is less frequent when compared to diabetic ketoacidosis (DKA) mortality rate is estimated to be as high as 20% (10 times higher than in diabetic ketoacidosis) (1). Gradually increasing polyuria and polydipsia will result in profound dehydration and electrolyte loss in a patient. in adults with HHS, fluid loss is estimated to be twice as those with DKA signs of dehydration may be less evident due to hypertonicity which preserves intravascular volume (1) Osmolality can be calculated from the formula: osmolality = 2(Na+K) + urea + glucose Note that serum sodium may be low, despite the fact that the patient is severely hyperosmolar. This is due to the redistribution of fluid into the extracellular fluid (secondary to the high glucose level). Reference: Continue reading >>

Hyperosmolar Hyperglycemic Nonketotic Syndrome

Hyperosmolar Hyperglycemic Nonketotic Syndrome

Tweet Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS), also known as Hyperosmolar Hyperglycaemic State (HHS) is a dangerous condition resulting from very high blood glucose levels. 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. What are the major warning signs of HHS for people with diabetes? Elevated blood sugar levels Extreme thirst Warm skin without sweat Fever Confusion or feeling sleepy Vision loss Hallucinations Nausea Weakness down one side of the body Who is at risk of Hyperosmolar Hyperglycaemic State? Periods of illness can significantly raise blood glucose levels, which could lead to Hyperosmolar Hyperglycaemic State (HHS) if medication is not sufficient to lower sugar levels. Having blood glucose levels above 33 mmol/l (600 mg/dl) for extended periods of time presents a risk of HHS occurring. Some serious complications of diabetes, such as Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS), usually manifest themselves amongst older people, who may be less aware of high blood glucose levels and how to treat them. What happens to diabetics who get HHNS? When HHNS affects a person with diabetes, blood sugar levels rise and the body passes excess sugar into the urine. This causes regular bathroom trips, and over time this affects the colour of the liquid. Dehydration can occur if you do not drink liquid regularly, and this can become severe and lead to coma, seizures and even death. What is the best way for people with diabetes to avoid HHNS? If you keep on top of your blood sugar levels, it is possible to avoid HHNS. By checking blood glucose regularly, people with diabetes can take action if a reading falls outside their target blood glucose ra Continue reading >>

Hyperglycemic Hyperosmolar Syndrome

Hyperglycemic Hyperosmolar Syndrome

Ads by Google Hyperglycemic hyperosmolar syndrome (HHS) is a type2 diabetes complication involving extremely high blood sugar levels without ketones. What is hyperglycemic hyperosmolar syndrome? Diabetic HHS is a condition of severely high blood sugar, extreme lack of water (dehydration), and decreased consciousness. Generally, there may be ketone’s build-up in the body often mild. HHS is usually developed among type2 diabetes and occasionally among undiagnosed patients. Alternative names are hyperglycemic-hyperosmolar coma, nonketotic-hyperglycemic hyperosmolar coma (NKHHC), or hyperosmolar-nonketotic coma (HONK). Most often, this condition has brought on by Poorly managed diabetes, Infection, Severe illness (such as infection, heart attack or stroke, and resent surgery), Poor kidney function, Older age, Medication increased fluid loss (such as diuretic). The kidney try removing this high blood glucose through urine, if you do not drink enough liquid or taking sugar-rich fluid makes it difficult for the kidney to remove excess glucose. HHS symptoms are coma, confusion, convulsions, fever, increased thirst, increased urination, lethargy, nausea, and fatigue. The condition worsens over time with severe symptoms such as dysfunctional movement, loss of feeling/function of muscles, and impaired speech. HHS diagnosis and tests HHS diagnosis is by examining the symptoms such as extreme dehydration, high fever, increased heart rate, and drop in systolic BP. Tests for diagnosis of HHS are blood osmolarity (concentration), BUN & creatinine levels, blood sodium level, ketone test, and blood-glucose test. Other evaluation tests include blood cultures, chest x-ray, electrocardiogram (ECG), and urinalysis. HHS treatment goal is to correct dehydration, normalize BP, improve urine o Continue reading >>

Managing Hyperosmolar Syndrome

Managing Hyperosmolar Syndrome

Go to site For Pet Owners Hyperosmolar syndrome is an uncommon complication of untreated feline diabetes mellitus. In animals in which target tissue resistance to insulin plays a role in the disease, insulin levels can be elevated. In these cases, ketosis is suppressed and plasma glucose concentrations can become very high. Diagnosis Physical examination often reveals profound dehydration, and the cat is typically lethargic, extremely depressed, or comatose. The severity of the hyperosmolality correlates directly with the severity of these signs. Hyperosmolar syndrome represents an emergency situation. Affected cats will become progressively weaker, anorexic, lethargic, and drink less. Ultimately, blood glucose levels become so high that osmosis shifts water from brain cells and coma results. Management guidelines Goals of management include correcting fluid deficits and electrolyte balance associated with severe dehydration, reducing blood glucose via insulin therapy, correcting the hyperglycemic, hyperosmolar state, and managing concurrent diseases. Fluid therapy is critical to alleviate this syndrome, especially in the first 4 to 6 hours of management. The goal is to reduce blood glucose at the rate of 50 mg/dL/hr. When the blood glucose approaches 300 mg/dL, the IV fluid selection should be changed to 5% dextrose solution. Intravenous isotonic fluid and insulin therapy usually resolve hyperosmolality, but must be done slowly to minimize the shift of water from the extracellular to the intracellular compartment. Delay insulin therapy (typically 4–6 hours) until fluid therapy has improved the cat’s condition, corrected dehydration and improved urine production, hyperglycemia, hyperosmolality, and electrolyte levels. Evaluation of management When evaluating the eff Continue reading >>

Hyperglycemic Hyperosmolar State

Hyperglycemic Hyperosmolar State

I. Diagnosis of Hyperglycemic Hyperosmolar State: a. Defined by a serum glucose >600, increased serum osmolality (>320 mosm), ph>7.30 and mild or no ketones b. Mild AG can occur (10-12), but higher AG should suggest a second process, such as lactic acidosis, etc. c. Mortality from HHS is 10-50% (much higher than in DKA, likely due to comorbid conditions in patients who develop HHS) d. Precipitating triggers: i. Infections, most commonly PNA, gram neg infxns, UTI (triggers in >50% of HHS) ii. Medications: non-compliance with DM meds (approx 20% of cases) or other new medications (steroids, diuretics, certain antipsychotic agents, TPN) iii. Undiagnosed DM iv. Acute MI v. Renal Failure vi. PE vii. CVA viii. Cushing’s syndrome ix. Substance abuse (etoh or cocaine) x. + others (think of almost any body stressor) II. Management of Hyperglycemic Hyperosmolar State*: a. IV Fluids: i. Pts with HHS are very volume depleted (often up to 8-9L) due to the osmotic dieresis; start with a 1L bolus of NS ii. If the patient is in hypovolemic shock, continue IVF boluses/volume expanders iii. If the patient has a normal BP or is mildly hypotensive, start maintenance fluids, based on the corrected Na (Na +1.6 (serum glucose-100/100) 1. If corrected Na is normal or high, start with 1/2 NS at a rate of 4-14ml/kg/hr, depending on degree of dehydration 2. If corrected Na is low, start with NS at a similar rate 3. Once serum glucose <300, add D5 to the IVF iv. If the patient is in cardiogenic shock, avoid IVF and treat underlying cardiac physiology first b. Insulin: i. Start with a bolus of IV regular insulin (0.15 units/kg, usually around 10 units) ii. Start an insulin gtt at 0.1 units/kg/hr; if serum glucose does not fall by 50-75mg/dL every hour, double the drip rate hourly until achieved i Continue reading >>

Diabetic Hyperglycemic Hyperosmolar Syndrome

Diabetic Hyperglycemic Hyperosmolar Syndrome

HHS; Hyperglycemic hyperosmolar coma; Nonketotic hyperglycemic hyperosmolar coma (NKHHC); Hyperosmolar nonketotic coma (HONK); Hyperglycemic hyperosmolar non-ketotic state; Diabetes - hyperosmolar 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. Causes HHS is a condition of: Buildup of ketones in the body (ketoacidosis) may also occur. But it is unusual and is often mild compared with diabetic ketoacidosis. HHS is more often seen in people with type 2 diabetes who don't have their diabetes under control. It may also occur in those who have not been diagnosed with diabetes. The condition may be brought on by: Infection Other illness, such as heart attack or stroke Medicines that decrease the effect of insulin in the body Medicines or conditions that increase fluid loss Normally, the kidneys try to make up for a high glucose level in the blood by allowing the extra glucose to leave the body in the urine. But this also causes the body to lose water. If you do not drink enough water, or you drink fluids that contain sugar and keep eating foods with carbohydrates, the kidneys may become overwhelmed. When this occurs, they are no longer able to get rid of the extra glucose. As a result, the glucose level in your blood can become very high. The loss of water also makes the blood more concentrated than normal. This is called hyperosmolarity. It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances. This draws the water out of the body's other organs, including the brain. Risk factors include: Symptoms Symptoms may include any of the following: Symptoms may get worse over days or weeks. Other symptoms Continue reading >>

Epidemiology Of Hyperglycemic Hyperosmolar Syndrome In Children Hospitalized In Usa.

Epidemiology Of Hyperglycemic Hyperosmolar Syndrome In Children Hospitalized In Usa.

Abstract BACKGROUND: Previous studies of hyperglycemic hyperosmolar syndrome (HHS) in children are limited to case series or single-institution reviews, which describe HHS primarily in children with type 2 diabetes mellitus. OBJECTIVE: To estimate the incidence and describe the epidemiologic characteristics of HHS among children in USA. SUBJECTS: All discharges in the Kids' Inpatient Database - a triennial, nationwide, stratified probability sample of hospital discharges for years 1997-2009 - with age 0-18 yr and a diagnosis of HHS. METHODS: Using sample weights, we calculated the incidence and population rate of hospitalization with a diagnosis of HHS. RESULTS: Our sample included 1074 HHS hospitalizations; of these, 42.9% were 16-18 yr, 70.6% had type 1 diabetes (T1D), and 53.0% had major or extreme severity of illness. The median length of stay was 2.6 d, 2.7% of hospitalizations ended in death, and median hospital charge was $10 882. When comparing HHS hospitalizations by diabetes type, the proportion with T1D fell steadily with age, from 89.1% among children 0-9 yr, to 65.1% in 16-18 yr olds. Patients with T1D had a shorter length of stay by 0.9 d, and had a lower median charge by $5311. There was no difference in mortality by diabetes type. Population rates for HHS hospitalization rose 52.4% from 2.1 to 3.2 per 1 000 000 children from 1997 to 2009. CONCLUSION: Hospitalizations for a diagnosis of HHS have high morbidity and are increasing in incidence since 1997. In contrast to prior reports, we found a substantial percentage of HHS hospitalizations occurred among children with T1D. © 2012 John Wiley & Sons A/S. Continue reading >>

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