Why does ketosis not develop in hyperglycemia?
What are the precipitating factors for HHNC?
What causes HHNC?
What is HHNC in diabetes?
How soon should you replace potassium in HHNC?
What is the loss of water in HHNC?
What drugs are involved in the development of HHNC?
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Whats the difference between DKA and HHNC?
DKA typically evolves within a few hours, whereas HHNS is much slower and occurs over days to weeks, according to 2021 research . The two conditions look similar because of the hyperglycemia component of each condition. Knowing the symptoms of each can help you seek medical care as soon as possible.
What is HHNS diabetes?
Hyperglycaemic hyperosmolar non-ketotic syndrome (HHNS) is a life-threatening complication of uncontrolled diabetes mellitus. This syndrome is characterised by severe hyperglycaemia, a marked increase in serum osmolality, and clinical evidence of dehydration without significant accumulation of ketoacids.
What's the difference between DKA and HHS?
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.
What is the cause of HHNS?
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.
Who is at risk for HHNS?
HHS most often affects people who have type 2 diabetes who are: Older (usually in their 60s or 70s). African-American, Native American or Hispanic. Affected by other health issues, such as infection, illness or heart conditions.
Does HHS need insulin?
All patients with HHS require IV insulin therapy; however, immediate treatment with insulin is contraindicated in the initial management of patients with HHS. The osmotic pressure that glucose exerts within the vascular space contributes to the maintenance of circulating volume in these severely dehydrated patients.
What is worse than DKA?
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 high does blood sugar have to be for DKA?
Your blood sugar level is higher than 300 milligrams per deciliter (mg/dL), or 16.7 millimoles per liter (mmol/L) for more than one test.
What are the 3 diagnostic criteria for DKA?
A diagnosis of diabetic ketoacidosis requires the patient's plasma glucose concentration to be above 250 mg per dL (although it usually is much higher), the pH level to be less than 7.30, and the bicarbonate level to be 18 mEq per L or less.
What is the treatment for HHS?
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 causes death in HHS?
Brain cells, which trap osmotically active particles, preferentially absorb water and swell during rapid rehydration. Cerebral edema follows, and, given the constraints of the cranium, uncal herniation may be the cause of death in persons with HHS.
Can HHS cause stroke?
Without prompt treatment, HHS can lead to complications such as cerebral oedema, electrolyte derangement, myocardial infarction, stroke, seizures and central pontine myelinolysis.
What is HHNK or HHNS?
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.
Which is worse DKA or HHS?
DKA typically affects people living with type 1 diabetes, whereas HHS usually occurs in people living with type 2 diabetes. HHS tends to be more dangerous than DKA, but both conditions can be deadly if a person does not receive treatment. Prompt medical attention is necessary in both cases.
Why is HHS worse than DKA?
Lack of ketosis likely is due to only a relative, rather than an absolute, lack of insulin, which reduces the development of ketones. Because HHS typically occurs in older individuals with underlying comorbidities, it has a significantly higher mortality rate than DKA.
What does DKA HHNS stand for?
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. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum.
DKA vs HHS (HHNS) NCLEX Review - Registered Nurse RN
DKA vs HHNS Diabetic Ketoacidosis. Affects mainly Type 1 diabetics; Ketones and Acidosis present; Hyperglycemia presents >300 mg/dL Variable osmolality; Happens Suddenly; Causes: no insulin present in the body or illness/infection; Seen in young or undiagnosed diabetics; Main problems are hyperglycemia, ketones, and acidosis (blood pH <7.35); Clinical signs/symptoms: Kussmaul breathing, fruity ...
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Hyperosmolar Hyperglycemic Syndrome - PubMed
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 pro …
Hyperosmolar, hyperglycemic, nonketotic coma in a patient receiving ...
A patient who developed hyperosmolar, hyperglycemic, nonketotic coma (HHNC) while receiving home total parenteral nutrient (TPN) therapy is described, and the etiology, clinical features, and treatment of HHNC are reviewed. A 51-year-old black man diagnosed as having Dukes' stage D signet-cell carci …
Hyperosmolar Hyperglycemic Syndrome - Cleveland Clinic
Overview What is hyperosmolar hyperglycemic syndrome (HHS)? 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 HHNS in diabetes?
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is a potentially deadly condition that can develop as a result of infection or illness in people with uncontrolled type 2 diabetes or when diabetes medications aren't taken as directed. Some also refer to this as a "diabetic coma.".
How long does it take for HHNS to show?
The symptoms of HHNS may appear slowly, taking days or even weeks to fully develop. Common symptoms include: 2
Why does HHNS happen?
This dehydration occurs because elevated levels of glucose cause blood to become thicker and result in the body needing to produce more urine in order to lower them. 3 .
How to tell if you have HHNS?
The symptoms of HHNS may appear slowly, taking days or even weeks to fully develop. Common symptoms include: 2 1 Blood glucose levels over 600 milligrams per deciliter (mg/dl) 2 Frequent urination 3 Extreme thirst 4 Dry mouth 5 Confusion or sleepiness 6 Skin that is warm and dry without sweating 7 Fever (usually over 101 F) 8 Weakness or paralysis on one side of the body 9 Loss of vision 10 Hallucinations
How to prevent HHNS?
The best way to prevent HHNS is by keeping your blood sugar levels under control. Test them regularly using a glucometer, work with your doctor to make sure you're taking any diabetes medications as prescribed, and learn the warning signs of elevated glucose levels and dehydration, such as extreme thirst and frequent urination, so you know to seek treatment when you need it. Educate your loved ones and coworkers to also recognize the early signs of blood sugar imbalance, so they can send for help, too.
How to diagnose HHNS?
HHNS is diagnosed based on symptoms and by measuring blood glucose levels, which can be performed with a finger stick. A blood glucose level of 600 mg/dL and low ketone levels are the main factors for diagnosis of HHNS. Serum osmolality, a test that measures the body's water/electrolyte balance , also is used to diagnose HHNS.
What causes a person to have a high urine output?
An infection, such as pneumonia or a urinary tract infection. Poor management of blood sugar and/or not taking diabetes medications as prescribed. Taking certain medications, such as glucocorticoids (which alter glucose levels) and diuretics (which increase urine output)
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What is HHNS in medical terms?
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is an emergency that the diabetes mellitus (DM) patient may experience. The condition is also commonly referred to as hyperglycemic hyperosmolar nonketotic coma (HHNC). However, recent literature has changed the name and reference from “coma” to “syndrome” since less than 10 percent ...
What is HHNS in blood?
HHNS is associated with severe elevations in the blood glucose level, often exceeding 600 mg/dL, from an absolute or relative insulin deficiency or from a decreased response of the tissue to the circulating insulin (insulin resistance). This results in glycogenolysis, gluconeogenesis, and a decreased uptake of glucose by the peripheral tissue.
What causes a lack of fluid intake in dementia patients?
The dementia typically causes a poor fluid intake from a lack of recognition of dehydration. Any condition or illness that results in dehydration increases the risk of HHNS in the patient with Type II DM. The mortality has been reported as high as 10 to 20 percent.
How much fluid is lost during osmotic diuresis?
The average fluid loss is typically 9 to ten liters in a 70 kg patient. A common cause of death is circulatory collapse.
How to administer oxygen to a patient with hypoxia?
Establish and maintain adequate oxygenation. Assess the patient for evidence of hypoxia. Apply a pulse oximeter and determine the SpO2 reading. If either clinical evidence of hypoxia exists or a SpO2 reading of less than 95 percent on room air is present, administer a high concentration of oxygen via a nonrebreather mask. If the patient is exhibiting no signs of hypoxia or the SpO2 reading is greater than 95 percent, supplemental oxygen may be applied via a nasal cannula at two to 4 lpm.
How to administer saline to a patient with osmotic diuresis?
Aggressive fluid resuscitation may be necessary in severe cases. Administer a bolus of 500 mL of normal saline in severely dehydrated patients. Lactated Ringer’s may also be used if normal saline is not available. In patients with a history of cardiac disease, congestive heart failure, or renal insufficiency, a 250 mL bolus should be used. Continuously reassess the patient for a response to the fluid administration and for evidence of over-hydration. Continue to administer fluid based on the patient’s hemodynamic status.
What causes death in the body?
A common cause of death is circulatory collapse. The change in the serum osmotic pressure may cause potassium, sodium, chloride, phosphate, magnesium and bicarbonate to be depleted from the tissues, even though the serum electrolyte levels may appear to be normal or elevated.
What is HHNS in medical terms?
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is also known as hyperglycemic hyperosmolar syndrome (HHS). It involves very high blood sugar levels and can be life threatening.
How long does it take for a DKA to evolve?
DKA typically evolves within a few hours, whereas HHNS is much slower and occurs over days to weeks, according to 2021 research. The two conditions look similar because of the hyperglycemia component of each condition.
What happens if your blood sugar is too high?
If your blood sugar gets too high, your kidneys try to excrete excess sugar through urination. When this happens, it’s known as hyperglycemia.
What to do if you have HHNS?
If you start to have symptoms of HHNS or DKA, call 911 or go to your local emergency room immediately. These are serious medical events that can lead to life threatening complications if left untreated.
What is a DKA?
Diabetic ketoacidosis (DKA) is a complication of type 1 diabetes and, less commonly, type 2 diabetes. When your blood sugar is very high, ketones (acidic substances) can accumulate in your blood at dangerous levels, causing DKA.
How many steps are there for HHNS?
A medical professional can typically treat HHNS using four steps:
What to do if you have symptoms of either condition?
If you have symptoms of either condition, seek emergency care immediately.
What is HHC, anyway?
HHC was first created in 1944 by the American chemist Roger Adams, when he added hydrogen molecules to Delta-9 THC. This process, known as hydrogenation, converts THC to hexahydrocannabinol (HHC).
How is HHC made?
It’s a many-step process. First, CBD is extracted from raw hemp, distilled and isolated in a powder form. From there, things get a little more complicated.
Is it safe to make HHC?
He told Leafly HHC can be produced safely in a well-equipped laboratory. But if you scale up production, he said, the risks rise, too. “The potential risk here is with explosions,” he explained.
What are the effects of HHC on the body and mind?
The complication arises, in part, from the fact that when the cannabinoid is manufactured, the end result is a mixture of two different kinds of HHC molecules: 9R HHC actively binds to the body’s natural endocannabinoid receptors, while 9S HHC, because of its slightly different molecular structure, doesn’t do so nearly as well.
How potent is HHC?
Kyle Ray, of Colorado Chromatography, told Leafly that while the ratios of the active and inactive HHC molecules can vary from batch to batch, they need to be at least 50% active to pass muster.
Does HHC show up on a drug test?
Burns, of Bearly Legal, believes that some of HHC’s appeal stems from evidence suggesting that it can evade drug tests. But—and this is important—he acknowledges the evidence is only anecdotal. This is just what he’s hearing from his customers.
Is HHC legal?
And now we arrive at perhaps the thorniest question of all: Is HHC legal?
Why does ketosis not develop in hyperglycemia?
The answer is not clear. Simplistically put, there appears to be enough insulin secretion to block ketogenesis but not enough to prevent hyperglycemia. It may also be that the hyperosmolarity itself suppresses ketone formation, as does the lower level of lipolytic hormones in patients with HHNC. 4 Whatever the reasons, patients with HHNC will typically have, at worst, a mild ketosis (perhaps from starvation as well as hyperglycemia) and mild accompanying acidosis (perhaps from lactic acidosis). Additionally, there are unusual patients who exhibit signs, symptoms, and laboratory parameters consistent with both DKA and HHNC.
What are the precipitating factors for HHNC?
2 Mortality is related to precipitating conditions, coexisting disease, and the older age of the patients who get HHNC; however, there has been no conclusive correlation between the degree of hyperglycemia or hyperosmolarity and mortality. Precipitating factors include: infection (particularly gram-negative infections), renal insufficiency, GI hemorrhage, stroke, myocardial infarction, and pancreatitis. Certain drugs have been implicated as precipitating factors in the development of HHNC. They include thiazide diuretics, furosemide, phenytoin, glucocorticoids, cimetidine, chlorpromazine, propranolol, chlorthalidone, and ethacrynic acid. Trauma, burns, surgery, dialysis, and hyperalimentation have been described as contributing to the development of HHNC. 3
What causes HHNC?
Since older patients are more likely to have pancreatic beta-cell insufficiency, this response may be inadequate. Physiologic stressors or precipitants of HHNC cause an increase in circulating catecholamines, which inhibits pancreatic insulin secretion and increases peripheral resistance to insulin. This combination of the inability to increase insulin secretion and the catecholamine-induced depression of insulin secretion and function leads to unchecked hyperglycemia. Because of compromised renal function from pre-existing renal disease and/or dehydration, glucose excretion is impaired, further aggravating hyperglycemia. An osmotic (hypotonic) diuresis occurs, worsening the dehydration and the body’s inability to excrete glucose. This vicious cycle leads to profound hyperglycemia, with serum glucose often above 1000 mg/dL. 2
What is HHNC in diabetes?
HHNC is a severe complication of diabetes mellitus. Diagnosis is predicated on recognizing the typical clinical presentation and confirmed by laboratory findings of profound hyperglycemia and hyperosmolarity, combined with an absence of significant ketosis or acidosis. Therapy is directed at aggressive fluid and electrolyte replacement and treatment of precipitating causes.
How soon should you replace potassium in HHNC?
One-half the estimated total body water deficit should be replaced in the first 12 hours. Potassium replacement should begin as soon as adequate renal function has been confirmed. Insulin requirements in HHNC are relatively small. Rehydration can go a long way toward reversing the pathophysiology described above.
What is the loss of water in HHNC?
However, because of the osmotic diuresis, a large amount of total body water is lost. Fluid losses in cases of HHNC typically range from 8-12 L. 4 Although the rate of water loss exceeds sodium loss, there is a significant depletion of total body sodium. The osmotic diuresis also causes a loss of potassium.
What drugs are involved in the development of HHNC?
They include thiazide diuretics, furosemide, phenytoin, glucocorticoids, cimetidine, chlorpromazine, propranolol, chlorthalidone, and ethacrynic acid. Trauma, burns, surgery, dialysis, and hyperalimentation have been described as contributing to ...
