Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. Diabetes occurs when there is a disbalance between the demand and production of the hormone insulin. The management of the hyperosmolar hyperglycaemic state hhs. Treatment begins with intensive monitoring of the patient and laboratory values. However, although treatment of diabetic ketoacidosis dka in children is familiar to. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. Pdf hyperglycaemic hyperosmolar state hhs in children. The pathophysiology of type 2 diabetes mellitus is characterized by peripheral. Hyperosmolar hyperglycemichyperosmolar hyperglycemic non ketotic comanon ketotic coma 1 presented by. Honk is distinct form dka, and the distinction is not entirely arbitrary, at least from the management point of. May 17, 2018 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. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes.
Honk diabetes pathophysiology when taken in smaller doses diabetic diet refers to their guidelines for patients with type 2 diabetes is a diet that special diabetes products. In the united states the populations most affected are native americans, particularly in the desert southwest, hispanicamericans, and asianamericans 1. Pdf discuss the pathogenesis, presentation and management of. The basics 7 diabetes 8 the impact of diabetes 8 insulin action 9 the epidemiology of type 1 diabetes 10 the pathophysiology of. Hyperglycemic hyperosmolar nonketotic syndrome hhs hhns. Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially. In both syndromes, there is insufficient insulin levels to transport.
Dec 23, 2015 hyperosmolar hyperglycaemic state hhs occurs in people with type 2 diabetes. In type 1 diabetes, symptoms tend to come on quickly and be more severe. Type 1 diabetes t1d is a disorder that arises following the autoimmune destruction of insulinproducing pancreatic b cells atkinson. Hhs and dka are of two of the most serious complications form diabetes. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. The pathogenesis and natural history of type 1 diabetes. Risk factors for hhs include newly diagnosed t2dm, being elderly, or having reduced ability for oral fluid replacement. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. Hyperosmolar hyperglycaemic state hhs, also known as nonketotic hyperglycaemic hyperosmolar syndrome nkhs, is characterised by profound hyperglycaemia glucose 33. Though a distinction is being made between diabetic ketoacidosis and honk, the two really form a part of the same disease spectrum. The name changed from honk hyperosmolar non ketotic coma to hyperosmolar. Hyperglycemic hyperosmolar nonketotic state honk is a clinical picture occurring in type ii diabetes, characterized by hyperglycemia, hyperosmolarity 350 mosml, and marked dehydration without ketosis. Hyperosmolar hyperglycemic state, diabetic hhs vs dka. It is very serious, but uncommon disorder seen typically in people with type 2 diabetes.
Hyperglycaemic hyperosmolar nonketotic coma honk diabetes. D eie rtie abstract diabetes mellitus dm is a metabolic disorder characterized by the presence of chronic hyperglycemia either. Hhs is characterized by extreme eleva tions in serum glucose concentrations. Very high blood glucose levels often over 40 mmoll develop as a result of a combination of illness, dehydration and an inability to take normal diabetes medication due to the effect of illness. It is a lifethreatening emergency that, although less common than its counterpart, diabetic ketoacidosis dka, has a much higher mortality rate, reaching up to 510%. Pdf hyperosmolar hyperglycaemic state hhs classically happens in type 2 diabetes, formerly recognised as hyperosmolar nonketotic. Whilst dka presents within hours of onset, hhs comes on over many days, and consequently the dehydration and metabolic disturbances are more extreme. Honk diabetes pathophysiology otelbeton diabetes food. Hyperglycemic hyperosmolar syndrome in children diabetes. Hyperglycaemic hyperosmolar nonketotic coma is a short term complication requiring immediate treatment by a healthcare professional. However, hhs is different and treatment requires a different approach. Hyperosmolar hyperglycaemic state hhs occurs in people with type 2 diabetes who experience very high blood glucose levels often over 40mmoll.
Pathophysiology of diabetes demographics type 1 diabetes and type 2 diabetes differentially impact populations based on age, race, ethnicity, geography, and socioeconomic status. Understanding diabetes and endocrinology pdf understanding diabetes and endocrinology pdf understanding diabetes and endocrinology pdf free download understanding diabetes and endocrinology ebook table of contents. Pathophysiology and clinical guidelines the academy of dental learning and osha training, llc, designates this activity for 7 continuing education credits 7 ces. Type 1 diabetes, also called insulin dependent diabetes mellitus iddm, is caused by lack of insulin secretion by beta. Hyperosmolar hyperglycemic state hhs is the nomenclature recommended by the american diabetes association to emphasize the varying alterations in sensorium less than coma that are usually present in humans and that hhs may occur with mild ketosis and acidosis nugent, 2005. Hhns vs dka are two complications of diabetes mellitus. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Oct 31, 2017 hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing. It can also occur in people with type 1 diabetes, but less commonly.
Diabetic hyperosmolar syndrome symptoms and causes mayo. Some ketoacidosis is present in honk, and some hyperosmolarity is present in dka. For instance, even though the conditions coexist 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. Diabetic ketoacidosis typically develops in patients who lack significant endogenous insulin. Over the last decade, major advances have been made in our understanding of the pathophysiology and molecular biology of type 2 diabetes 1,2. Hyperglycaemic hyperosmolar nonketotic coma is a dangerous condition brought on by very high blood glucose levels in type 2 diabetes above 33 mmoll. This used to be called hyperosmolar nonketotic state honk. Hyperosmolar hyperglycaemic state symptoms, diagnosis. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Hyperosmolar hyperglycemic state, or hhs, is another acute and lifethreatening complication of diabetes mellitus. Hyperglycaemic hyperosmolar state hhs, also known previously as hyperosmolar hyperglycaemic nonketotic coma honk is a lifethreatening but preventable acute metabolic complication of diabetes.
Racgp hyperglycaemic presentations in type 2 diabetes. Honk is distinct form dka, and the distinction is not entirely arbitrary, at least from the management point of view. 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. Patients with dka or hhs present with hyperglycemia and dehydration and frequently appear quite ill physically. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are frequently encountered in the ed. Diabetes symptoms vary depending on how much your blood sugar is elevated. People with diabete type 2 et migraine insipidus can pass between 3 and 20 quarts a day. Hyperosmolar non ketotic hypergycaemic coma honk deranged. Hyperosmolar hyperglycaemic syndrome hhs hhs is the most likely diagnosis in the above case study.
Pathophysiology of type 2 diabetes and its treatment policy. Pathophysiology of type 2 diabetes and its treatment policy jmaj 531. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur. Hyperglycemic hyperosmolar syndrome hhs is a potentially life threatening condition involving extremely high blood sugar glucose levels when your blood sugar gets too high, the kidneys try. Management of hyperglycaemic hyperosmolar state hhs the complex pathophysiology and management of hhs means that level 2 care is usually the most appropriate, with early input from specialist inpatient diabetes team via trakcare. It develops slower than dka, typically in the course of several days, but has a. Hyperosmolar hyperglycaemic state symptoms, diagnosis and. When food is taken, it is broken down into smaller components.
Oct 10, 2014 the hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. It can develop over a course of weeks through a combination of illness e. Part of managing your diabetes will be to check your urine for ketones. Last words this products starting line up the flat blade and the cross blade do not do ice well. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Diabetic hyperosmolar hipurozmoelur syndrome is a serious condition caused by extremely high blood sugar levels. Honk diabetes pathophysiology diabetes mellitus education. Type 2 diabetes is a bipolar disease characterized by a defect in both insulin. Understanding diabetes and endocrinology pdf download. The hyperosmolar hyperglycemic state hhs is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. Whenever there is hyperglycemia, the brain recognizes it and send a message through nerve impulses to pancreas and other organs to decrease its effect 30. Hyperglycemic hyperosmolar nonketotic syndrome medind.
Symptoms of honk before loss of consciousness and coma takes place, patients will display signs of. Unlike the other common diabetes emergency, diabetic ketoacidosis dka, guidelines on the. Diabetic ketoacidosis is defined by a triad of hyper. 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. Leibel naomi berrie diabetes center 25 february 2008 body mass index chart 2529. Differentiation of diabetes by pathophysiology, natural. But whether i do or dont i once played with a famous football player in the old nfl golf classic. Hyperosmolar hyperglycaemic state hhs is a diabetic emergency that. Very high blood glucose levels often over 50 mmoll 900 mgdl. 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. Symptoms of honk before loss of consciousness and coma takes place. Diabetic emergencies ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. The management of the hyperosmolar hyperglycaemic state.
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