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What Is The Key Differentiating Factor Between Dka And Hhs

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Session 5 - Difference Between Diabetic Ketoacidosis ( DKA ) And Hyperosmoler Hyperglycemic ( HHS ) ( Dr/ Razan Agha )

Differentiating Between Dka And Hhs.

Authors: Christy McDonald Lenahan, MSN, RN, FNP-BC, and Brenda Holloway, DNSc, MSN, RN, FNP-BC, Lafayette, LA, Mobile, AL wo of the most common metabolic emergencies associated with diabetes mellitus are diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS). 1 Although each disorder results in severe hyperglycemia, the underlying pathophysiology, clinical presentation, and treatment are vastly different. 2 It is imperative that clinicians be keenly aware of these differences, considering the variation in clinical pathways associated with each hyperglycemic emergency. 3 This article will compare and contrast the epidemiology, associated risk factors, differential diagnoses, clinical presentation, diagnosis, and medical management of DKA and HHS. Persons of African American ethnicity and older persons are at an increased risk for the development of HHS. 8 Rates of hospital admissions associated with HHS are signicantly lower than those associated with DKA and account for less than 1% of all diabetic-related admissions. 3 It should be noted, however, that between the years of 1997 and 2009 there was a 52.4% increase in the HHS hospitalization rate among children and Continue reading >>

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  1. glasstambourine

    I've struggled with anxiety and depression in the past, but it hasn't been an issue for me for about four years. Ever since I started keto about five weeks ago, I have been getting random anxiety and mild panic attacks. For example, a few nights ago I was sitting on the couch with my boyfriend watching RuPauls Drag Race (which usually makes me laugh and smile nonstop) and I just started freaking out. It happens a lot at night when I am going to sleep as well. I have several nightmares a week, usually involving someone trying to kill me. Nothing in my life has changed recently other than my diet. I consider myself to be a very happy, social, and laid back woman.
    Just curious is anyone else has experienced this. For the record, I absolutely love keto. I've never felt stronger, more energetic, and in control of my food intake in my life.

  2. glasstambourine

    Just ordered some Natural Calm on amazon per your recommendation. The only liquid sweetener I use is liquid stevia, so ill cut that out for a week to see if it makes a difference.
    I drink over a gallon of water a day. I did before keto even, I just happen to love ice water and sparkling water.
    Thank you for your thoughtful response. Knowing other people have similar issues is comforting.

  3. [deleted]

    Natural calm is easily absorbed by the body. You may only need it once or twice a week. Your body will let you know. Any that isn't needed will give you loose stools. So go easy on it at first. I heat up a few ounces of water, add the powder and when its done fizzing I add cold water. I still have the box I ordered a few months ago. :)

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Hyperglycemic crises: Hyperglycemic hyperosmolar nonketotic coma (HHNK) versus DKA. See DKA video here: https://youtu.be/r2tXTjb7EqU This video and similar images/videos are available for instant download licensing here https://www.alilamedicalmedia.com/-/g... Voice by: Penelope Hammet Alila Medical Media. All rights reserved. All images/videos by Alila Medical Media are for information purposes ONLY and are NOT intended to replace professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition. Support us on Patreon and get FREE downloads and other great rewards: patreon.com/AlilaMedicalMedia Hyperosmolar hyperglycemic state, or HHS, is another ACUTE and life-threatening complication of diabetes mellitus. It develops slower than DKA, typically in the course of several days, but has a much higher mortality rate. Like DKA, HHS is triggered when diabetic patients suffer from ADDITIONAL physiologic stress such as infections, other illness, INadequate diabetic treatment or certain drugs. Similar to DKA, the RISE in COUNTER-regulatory hormones is the major culprit. These hormones

Management Of The Hyperosmolar Hyperglycaemic State (hhs) In Adults With Diabetes (aug 2012)

Management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes (Aug 2012) Management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes (Aug 2012) Unlike the other common diabetes emergency, diabetic ketoacidosis (DKA), guidelines on the management of the hyperglycaemic hyperosmolar state (HHS) in adults are uncommon and often there is little to differentiate them from the management of DKA. However, HHS is different and treatment requires a different approach. The person with HHS is often elderly, frequently with multiple co-morbidities but always very sick. Even when specific hospital guidelines are available, adherence to and use of these is variable amongst the admitting teams. In many hospitals these patients are managed by non-specialist teams, and it is not uncommon for the most junior member, who is least likely to be aware of the hospital guidance, to be given responsibility for the initial management of this complex and challenging condition. Diabetes specialist teams are rarely involved at an early stage and sometimes never at all. To address these issues the Joint British Diabetes Societies (JBDS) for inpatient care, supported by Continue reading >>

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  1. an ex

    Title.
    Let's say you follow a ketogenic diet for 2 weeks, and then perhaps over the weekend you eat A LOT of carbs! everything your heart desires! enough to knock you out of ketosis basically, then how long does it take to get back into ketosis after resuming keto diet?
    and what's happening to your body during that time?
    For those very knowledgeable regarding ketogenic diet and ketosis, please help shed some light.

  2. Cyborg_Minerva

    IME, if you were in a good strong ketosis before, it shouldn't take too long. You have to burn through the extra carbs you just ate, plus however many you eat on top of that. So if you eat none (going full keto from here on out, or fasting entirely), it may only take 12-24 hours. If you go back to your regular low carb it might take 36-48 hours. But it shouldn't take like, 3 days or anything.
    ...I mean, how many carbs are we talking, lol

  3. an ex

    Cyborg_Minerva, on 16 Sept 2017 - 1:19 PM, said:
    IME, if you were in a good strong ketosis before, it shouldn't take too long. You have to burn through the extra carbs you just ate, plus however many you eat on top of that. So if you eat none (going full keto from here on out, or fasting entirely), it may only take 12-24 hours. If you go back to your regular low carb it might take 36-48 hours. But it shouldn't take like, 3 days or anything.
    ...I mean, how many carbs are we talking, lol
    So i have to deplete my body of the carbs i ate before flowing back into ketosis; that makes sense!! the more carbs i eat the longer it takes \
    thank u very much!!

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A lecture on the recognition, pathogenesis, and management of diabetic ketoacidosis and the hyperosmolar hyperglycemic state. Use of the VA and Stanford name/logos is only to indicate my academic affiliation, and neither implies endorsement nor ownership of the included material.

Hyperglycemic Crises

- ECG, CXR, cultures (blood, urine, sputum, etc) - correct insulin deficiency: IV insulin bolus, IV insulin continuous infusion - maintain electrolyte balance: sodium, potassium, calcium, magnesium, phosphate, bicarbonate - identify precipitating causes: starvation, dementia, medications, infection - frequent patient monitoring (clinical and laboratory) - restores intravascular and intracellular volume - rapid hydration facilitates insulin correction of hyperosmolar state - must monitor for electrolyte changes: sodium, postassium, calcium, magnesium, phosphate, bicarbonate - presence of hemodynamic instability or comorbid conditions may influence rehydration strategy (hypotension, CHF, fluid overload, CKD) - IV normal saline (NS 0.9% NaCl) infused at a rate of 15-20 ml/kg/h for one hour (1-1.5 liters) -- normo or hypernatremia: IV 1/2 NS 250-500 ml/h -- used corrected Na when BG >100 mg/dl (corrected Na = Na + 1.6 x each 100 mg/dl greater than 100 mg/dl) - when blood glucose reaches 200 mg/dl (DKA) or 300 mg/dl (HHS) change to 5% dextrose (D5W) and 1/2 NS at 150-250 ml/h - DO NOT START if K <3.3 meq/L - REPLACE K FIRST (can cause arrthymia) - IV route preferred: easier to titrate, Continue reading >>

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  1. 3kidlets

    Hana had trace ketones on Thanksgiving. For no reason that I could pinpoint, she woke up with BS of 300 on Thursday. We went to watch my son run a 5K and when we got back, she was 400+ (after eating and doing major correction to the 300). She used the ketone strips and had trace ketones. The thing is, we had to drive 2 hours to CT for the day and it would have been much easier to have the BS monitor that detects ketones than to have her pee on a stick when we stopped for a bathroom break!
    I bought what I thought was the meter - it is Abbott Precision XTRA but on the package it doesn't say anything about ketones but when I opened it up, I did find a pamphlet inside saying something about them switching over to new strips for ketones. I could not find any test strips in Walmart that said they were for ketone testing with this meter - only found blood sugar test strips for the Precision Xtra, so I did not buy them. Did I buy the right meter??? Where do you find the strips? I just want to have them on hand for days like we had on Thanksgiving - not to use on a regular basis.

  2. gsmama

    The strips are have for it are by prescription only. They are $10.00 a strip I believe.

  3. Moifry

    It will do blood sugar and Ketones, but you need different strips for the ketones. They are quite expensive, but much easier to use than the pee sticks. Any pharmacy should have them or be able to get them .

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