what is dm with hyperosmolarity

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Diabetic hyperglycemic hyperosmolar syndrome. 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. HHS is a condition of:

What is diabetic hyperglycemic hyperosmolar syndrome?

It's often triggered by illness or infection. In 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.

What causes hyperosmolar syndrome?

Hyperosmolarity most often affects people living with type 2 diabetes, particularly older people who do not have their type 2 diabetes well managed. Rarely, hyperosmolarity affects children and young adults who have type 1 or type 2 diabetes, and obesity is a factor in these situations.

How does hyperosmolarity affect Type 2 diabetes?

There are some clear symptoms of hyperosmolarity, the most obvious being extremely elevated blood sugar defined as 600 milligrams per deciliter (mg/dL), with 400 mg/dL as the threshold for seeking emergency care. The key is not waiting until you have hyperosmolarity, but rather treating high blood sugar before the condition happens.

What are the symptoms of hyperosmolarity?

What does Hyperosmolarity mean?

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.

Is DM with Hyperosmolarity an emergency?

Hyperosmolar hyperglycemic state (HHS) is one of two serious metabolic derangements that occur in patients with diabetes mellitus (DM). It is a life-threatening emergency that, although less common than its counterpart, diabetic ketoacidosis (DKA), has a much higher mortality rate, reaching up to 5-10%.

How is Hyperosmolarity diagnosed?

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.

What can cause hyperosmolar state?

Hyperosmolar Hyperglycaemic State (HHS) occurs in people with type 2 diabetes who experience very high blood glucose levels (often over 40mmol/l). It can develop over a course of weeks through a combination of illness (e.g.infection) and dehydration.

At what sugar level is diabetic coma?

A diabetic coma could happen when your blood sugar gets too high -- 600 milligrams per deciliter (mg/dL) or more -- causing you to become very dehydrated. It usually affects people with type 2 diabetes that isn't well-controlled. It's common among those who are elderly, chronically ill, and disabled.

How does Hyperosmolarity cause coma?

Nonketotic hyperosmolar coma is characterized by extremely high plasma glucose without acidosis. Glucose values can exceed 1000 mg/dl, which constitutes sufficient osmolar load to produce significant changes in water compartmentalization. Symptoms generally include polyuria and polydipsia with obtundation or lethargy.

How is hyperosmolar hyperglycemic state treated?

Treatment. Treatment of HHS requires a four-pronged approach: (1) vigorous intravenous rehydration, (2) electrolyte management, (3) intravenous insulin, and (4) diagnosis and management of precipitating and coexisting problems.

What are the warning signs of diabetic ketoacidosis?

DKA Signs and SymptomsFast, deep breathing.Dry skin and mouth.Flushed face.Fruity-smelling breath.Headache.Muscle stiffness or aches.Being very tired.Nausea and vomiting.More items...•

What is the major difference between diabetic ketoacidosis and hyperglycemic hyperosmolar state?

DKA is characterized by ketoacidosis and hyperglycemia, while HHS usually has more severe hyperglycemia but no ketoacidosis (table 1). Each represents an extreme in the spectrum of hyperglycemia. The precipitating factors, clinical features, evaluation, and diagnosis of DKA and HHS in adults will be reviewed here.

Why do diabetics retain water?

So, how are diabetes and water retention related? The most common type of water retention is in the legs and feet (peripheral edema). Sometimes, water retention occurs as a side effect of insulin therapy or diabetes drugs. Peripheral edema is sometimes a symptom of kidney problems or heart failure related to diabetes.

How do you fix Hyperosmolality?

Treatment of HHS Treatment is 0.9% (isotonic) saline solution at a rate of 15 to 20 mL/kg/hour, for the first few hours. After that, the corrected sodium should be calculated. If the corrected sodium is < 135 mEq/L (< 135 mmol/L), then isotonic saline should be continued at a rate of 250 to 500 mL/hour.

Does Hyperosmolarity cause edema?

Cerebral edema occurs when fluid moves from the extracellular to intracellular space faster than brain cells can adapt to increased intracellular volume. This can happen when hypernatremia or hyperglycemia is corrected too rapidly, leading to a sudden and pronounced drop in serum osmolality.

Which intervention is indicated to treat a patient with DKA?

Insulin reverses the processes that cause diabetic ketoacidosis. In addition to fluids and electrolytes, you'll receive insulin therapy — usually through a vein.

What should I monitor for HHNS?

Monitor serum sodium and potassium levels closely. If needed, use isotonic and hypotonic saline solutions to adjust the patient's sodium level.

What is the term for a person who has high blood sugar?

Hyperosmolar hyperglycemic syndrome ( HHS) is a serious complication of diabetes mellitus. HHS occurs when a person’s blood glucose (sugar) levels are too high for a long period, leading to severe dehydration (extreme thirst) and confusion.

What is the name of the condition where blood sugar levels are high for a long period of time?

Hyperosmolar Hyperglycemic Syndrome. A serious complication of diabetes mellitus, hyperosmolar hyperglycemic syndrome (HHS) happens when blood sugar levels are very high for a long period of time. Symptoms of HHS can include extreme thirst, frequent urination, changes in your vision and confusion.

What happens when blood sugar is too high?

HHS occurs when the blood sugar of a person with diabetes becomes too high (hyperglycemia) for a long time. The extra sugar is passed into the urine, which causes the person to urinate frequently. As a result, he or she loses a lot of fluid, which can lead to severe dehydration (extreme thirst).

How long does it take for HHS to show symptoms?

Symptoms of HHS usually come on slowly, and can take days or weeks to develop. Symptoms include:

How to reduce risk of HHS?

You can reduce your risk of developing HHS again by controlling your diabetes and managing your diet and lifestyle.

Why does glucose build up in the body?

The glucose builds up because their bodies either don’t make enough insulin, or have trouble using the insulin that they do make. (Insulin is a naturally occurring hormone, produced by the beta cells of the pancreas, which helps the body use sugar for energy.)

What to do if you have symptoms of HHS?

If you have symptoms of HHS, you should drink plenty of water and call 911 or go to the emergency room immediately . You will receive an IV with fluids and insulin to relieve your symptoms.

What is hyperosmolar hyperglycemic syndrome?

Hyperosmolar hyperglycemic syndrome (HHS) is a clinical condition that arises from a complication of diabetes mellitus. This problem is most commonly seen in type 2 diabetes. Won Frerichs and Dreschfeld first described the disorder around 1880. They described patients with diabetes mellitus with profound hyperglycemia and glycosuria without the classic Kussmaul breathing or acetone in the urine seen in diabetic ketoacidosis. This clinical condition was formerly called non-ketotic hyperglycemic coma; hyperosmolar hyperglycemic non-ketotic syndrome, and hyperosmolar non-ketotic coma (HONK).[1]

Why do people with type 2 diabetes have HHS?

As stated earlier, HHS is most commonly seen in patients with type 2 diabetes. If diabetes mellitus is well controlled, the chance of developing HHS is minimal. However, under certain conditions, some factors might initiate the development of HHS. The most frequent reason for this complication is infection. The infectious process in the respiratory, gastrointestinal, and genitourinary systems can act as the causative factor. The reason for this is the insensible water loss and the release of endogenous catecholamines. Approximately 50% to 60% of HHS is attributable to an infectious etiology. [11][12][13]

What is the clinical presentation of HHS?

The typical clinical presentation of patients with HHS is increased urination (polyuria) and increase water intake (polydipsia). This is a result of the stimulation of the thirst center in the brain from severe dehydration and increased serum osmolarity. Weakness, malaise, and lethargy can also be part of the complaints.

When is DKA more common?

Typically DKA is more common in the younger population with the peak age around the fourth decade of life. [17][18]

Why should glucose levels be monitored?

The glucose level should be monitored hourly to guard against a sudden and precipitous drop, during treatment with isotonic fluid and insulin. This is to prevent the development of cerebral edema which is the most dreaded complication in both DKA and HHS. The risk of cerebral edema is higher in HHS.

What is the metabolic effect of diabetes mellitus?

Diabetes mellitus is a clinical condition associated with hyperglycemia as the main metabolic disorder.[2]  This is as a result of an absolute or relative deficiency of insulin. Insulin is an anabolic hormone produced by the beta cells of the islets of Langerhans in the pancreas. The main function of this hormone is to lower the level of glucose in the blood by promoting the uptake of glucose by the adipose tissue and skeletal muscle, known as glycogenesis. Insulin also inhibits the breakdown of fat in the adipose tissue, known as lipolysis. The metabolic effect of insulin is countered by hormones such as glucagon and catecholamines. [3]

What is the most common complication of type 1 diabetes?

Only about 5% to 10% of all diabetes falls into this category. The most common complication of type 1 diabetes is diabetic ketoacidosis (DKA).

What is HHS in diabetes?

HHS is a condition of: Extremely high blood sugar (glucose) level. Extreme lack of water ( dehydration ) 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 ...

Why does the kidneys lose water?

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.

What happens when you lose water in your blood?

The loss of water also makes the blood more concentrated than normal. This is called hyperosmolarity.

What does a health care provider examine you for?

The health care provider will examine you and ask about your symptoms and medical history. The exam may show that you have:

What is it called when the blood has a high concentration of salt?

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: A stressful event such as infection, heart attack, stroke, or recent surgery. Heart failure.

What happens if you don't treat HHS?

If not treated right away, seizures, coma, or death may result. This condition is a medical emergency. Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of HHS. Controlling type 2 diabetes and recognizing the early signs of dehydration and infection can help prevent HHS.

How to prevent HHS?

Controlling type 2 diabetes and recognizing the early signs of dehydration and infection can help prevent HHS.

What is hyperosmolar hyperglycemic syndrome?

Hyperosmolar hyperglycemic syndrome (HHS) is a clinical condition that arises from a complication of diabetes mellitus. This problem is most commonly seen in type 2 diabetes. Won Frerichs and Dreschfeld first described the disorder around 1880.

What is the metabolic disorder of diabetes mellitus?

Diabetes mellitus is a clinical condition associated with hyperglycemia as the main metabolic disorder. This is as a result of an absolute or relative deficiency of insulin. Insulin is an anabolic hormone produced by the beta cells of the islets of Langerhans in the pancreas. The main function of this hormone is to lower the level of glucose in the blood by promoting the uptake of glucose by the adipose tissue and skeletal muscle, known as glycogenesis. Insulin also inhibits the breakdown of fat in the adipose tissue, known as lipolysis. The metabolic effect of insulin is countered by hormones such as glucagon and catecholamines.

What is the most common complication of type 1 diabetes?

The most common complication of type 1 diabetes is diabetic ketoacidosis ( DKA). Type 2 diabetes accounts for about 90% to 95% of diabetes cases. It is most commonly seen in patients with obesity. As a consequence of the obesity and high body mass index (BMI), there is the resistance of the peripheral tissue to the action of insulin.

What is the mortality rate in HHS?

The mortality rate in HHS can be as high as 20% which is about 10 times higher than the mortality seen in diabetic ketoacidosis. Clinical outcome and prognosis in HHS are determined by several factors: age, the degree of dehydration, and the presence or lack of other comorbidities.

Which cell in the pancreas produces insulin?

The beta-cell in the pancreas continues to produce insulin, but the amount is not enough to counter the effect of the resistance of the end organ to its effect. HHS is a serious and potentially fatal complication of type 2 diabetes.

Does insulin cause lipolysis?

Insulin also inhibits the breakdown of fat in the adipose tissue, known as lipolysis. The metabolic effect of insulin is countered by hormones such as glucagon and catecholamines. In type 1 diabetes, there is the autoimmune destruction of the beta cells in the pancreas.

What is HHS in medical terms?

Outlook. Prevention. 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 to compensate by removing some of the excess glucose through urination. If you don’t drink enough fluids to replace ...

What is HHS treatment?

Untreated HHS can lead to life threatening complications, including: dehydration. shock. coma. HHS is a medical emergency.

How to prevent HHS?

The best way to prevent HHS is to monitor your diabetes carefully and manage it.

What does a physical exam show?

A physical exam will show if you have: dehydration. fever. low blood pressure. rapid heart rate. Your doctor will likely use a blood test to diagnose this condition. The blood test checks your current blood sugar level. Your doctor will diagnose HHS if your blood sugar is 600 milligrams per deciliter (mg/dL) or higher.

How to know if you have HHS?

Failure to monitor and manage blood glucose levels can also lead to HHS. Symptoms may develop slowly and increase over a period of days or weeks. Possible symptoms include: excessive thirst. increased urination. fever. Treatment involves reversing or preventing dehydration and managing blood glucose levels.

Why is HHS a result of diabetes?

Blood that’s too concentrated begins to draw water out of other organs, including the brain. Any illness that makes you dehydrated or reduces your insulin activity can lead to HHS. It’s commonly a result of unmanaged or undiagnosed diabetes. An illness or infection can trigger HHS.

What to do if you have symptoms of HHS?

Go to the emergency room or call 911 right away if you have symptoms of HHS.

What Are the Warning Signs?

If you have diabetes and you’ve had a heavy thirst and gone to the bathroom more often than usual for a few weeks, check with your doctor -- especially if your blood sugar isn’t well-controlled. As your body loses more and more water, you may notice:

How Is It Treated?

Once your doctor spots the early signs, they may send you to the hospital. You’ll get an IV to replace lost fluids and electrolytes such as potassium. And you’ll get insulin or other medication to control your blood sugar. The coma can lead to death if left untreated.

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. In diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing it into your uri...

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