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What Is Hyperglycemic Hyperosmolar Syndrome?

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 >>

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 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 >>

Hyperosmolar Hyperglycemic State (hhs)

Hyperosmolar Hyperglycemic State (hhs)

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. 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 causes severe dehydration and makes the person's blood abnormally concentrated (hyperosmolar). Thus, the disorder is called hyperosmolar hyperglycemic state. Symptoms The main symptom of hyperosmolar hyperglycemic state is a mental change. The change ranges from mild confusion and disorientatio Continue reading >>

Diabetic Hyperglycemic Hyperosmolar Syndrome

Diabetic Hyperglycemic Hyperosmolar Syndrome

What is diabetic hyperglycemic hyperosmolar syndrome? Hyperglycemic hyperosmolar syndrome (HHS) is a potentially life-threatening condition involving extremely high blood sugar, or glucose, levels. Any illness that causes dehydration or reduced insulin activity can lead to HHS. It’s most commonly a result of uncontrolled or undiagnosed diabetes. An illness or infection can trigger HHS. Failure to monitor and control blood glucose levels can also lead to HHS. When your blood sugar gets too high, the kidneys try to compensate by removing some of the excess glucose through urination. If you don’t drink enough fluids to replace the fluid you’re losing, your blood sugar levels spike. Your blood also becomes more concentrated. This can also occur if you drink too many sugary beverages. This condition is called hyperosmolarity. Blood that’s too concentrated begins to draw water out of other organs, including the brain. Some possible symptoms are excessive thirst, increased urination, and fever. Symptoms may develop slowly and increase over a period of days or weeks. Treatment involves reversing or preventing dehydration and getting blood glucose levels under control. Prompt treatment can relieve symptoms within a few hours. Untreated HHS can lead to life-threatening complications, including dehydration, shock, or coma. Go to an emergency room or call 911 if you have symptoms of HHS. This is a medical emergency. HHS can happen to anyone. It’s more common in older people who have type 2 diabetes. Symptoms may begin gradually and worsen over a few days or weeks. A high blood sugar level is a warning sign of HHS. The symptoms include: excessive thirst high urine output dry mouth weakness sleepiness a fever warm skin that doesn’t perspire nausea vomiting weight loss leg 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 State: An Emerging Pediatric Problem

Hyperglycemic Hyperosmolar State: An Emerging Pediatric Problem

In his 1886 Bradshawe lecture on diabetic coma, Dreschfeld described a relatively uncommon form that he and other European authors had noted, in which dyspnea and the acetone smell of the breath were absent, and the urine did not contain acetone or aceto-acetic acid.1 He described a clinical presentation of shock occurring chiefly, but not exclusively, in older people who had diabetes symptoms for some time and were, “still stout and well-nourished at the time of attack.” Despite this early description and occasional subsequent reports of diabetic coma without significant ketosis/acidosis,2,3 the report of Sament and Schwartz4 in 1957 is widely credited as the original description of what has been variously referred to as hyperosmolar nonketotic coma, hyperglycemic hyperosmolar nonketotic syndrome, hyperosmolar nonacidotic uncontrolled diabetes, diabetic hyperosmolar state, and hyperglycemic hyperosmolar coma or syndrome (HHS). To access this article, please choose from the options below You searched for T2D in All Content Showing: 1-20 You searched for T2D in All Content Showing: 21-40 You searched for T2D in All Content Showing: 41-60 You searched for T2D in All Content Showing: 61-80 You searched for T2D in All Content Showing: 81-100 You searched for T2D in All Content Showing: 101-120 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 >>

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 >>

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 >>

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 >>

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

Hyperosmolar hyperglycemic state is a life-threatening emergency manifested by marked elevation of blood glucose, hyperosmolarity, and little or no ketosis. With the dramatic increase in the prevalence of type 2 diabetes and the aging population, this condition may be encountered more frequently by family physicians in the future. Although the precipitating causes are numerous, underlying infections are the most common. Other causes include certain medications, non-compliance, undiagnosed diabetes, substance abuse, and coexisting disease. Physical findings of hyperosmolar hyperglycemic state include those associated with profound dehydration and various neurologic symptoms such as coma. The first step of treatment involves careful monitoring of the patient and laboratory values. Vigorous correction of dehydration with the use of normal saline is critical, requiring an average of 9 L in 48 hours. After urine output has been established, potassium replacement should begin. Once fluid replacement has been initiated, insulin should be given as an initial bolus of 0.15 U per kg intravenously, followed by a drip of 0.1 U per kg per hour until the blood glucose level falls to between 250 and 300 mg per dL. Identification and treatment of the underlying and precipitating causes are necessary. It is important to monitor the patient for complications such as vascular occlusions (e.g., mesenteric artery occlusion, myocardial infarction, low-flow syndrome, and disseminated intravascular coagulopathy) and rhabdomyolysis. Finally, physicians should focus on preventing future episodes using patient education and instruction in self-monitoring. Hyperosmolar hyperglycemic state is a relatively common, life-threatening endocrine emergency that is reported in all age groups,1 but it most Continue reading >>

What Is Hyperosmolar Hyperglycemic Nonketotic Syndrome?

What Is Hyperosmolar Hyperglycemic Nonketotic Syndrome?

Having diabetes means that there is too much sugar (glucose) in your blood. When you eat food, your body breaks down much of the food into glucose. Your blood carries the glucose to the cells of your body. An organ in your upper belly, called the pancreas, makes and releases a hormone called insulin when it detects glucose. Your body uses insulin to help move the glucose from the bloodstream into the cells for energy. When your body does not make insulin (type 1 diabetes), or has trouble using insulin (type 2 diabetes), glucose cannot get into your cells. The glucose level in your blood goes up. Too much glucose in your blood (also called hyperglycemia or high blood sugar) can cause many problems. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome (HHNS). It is very rare in people with type 1 diabetes. HHNS is an emergency caused by very high blood sugar, often over 600 mg/dL. Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine. This makes you urinate more and you lose too much body fluid, causing dehydration. As you lose fluids, your blood becomes thicker and your blood sugar level gets too high for the kidneys to be able to fix. With the high blood sugar and dehydration there is also an imbalance of minerals, especially sodium and potassium in the blood. The imbalance of fluids, glucose, and minerals in the body can lead to severe problems, such as brain swelling, abnormal heart rhythms, seizures, coma, or organ failure. Without rapid treatment, HHNS can cause death. What can I expect in the hospital? You will need to stay in the hospital in order to bring your blood sugar level under control and treat the cause of the HHNS. Several things may be done while you are in the ho Continue reading >>

Diabetic Hyperglycemic Hyperosmolar Syndrome

Diabetic Hyperglycemic Hyperosmolar Syndrome

Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a potentially life threatening condition when a patient has extremely high blood sugar (glucose). It is usually a complication of type 2 diabetes and leads to severe dehydration and loss of consciousness if not treated. When infection, illness or medications spurs extremely high blood sugar in patients with type 2 diabetes, the cells do not have enough insulin or don’t respond to the insulin. The kidneys try to expel the glucose with increased urination. During diabetic hyperglycemic hyperosmolar syndrome, the body becomes extremely dehydrated. This level of dehydration can cause serious symptoms, including convulsions and coma. Continue reading >>

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