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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. Hyperosmolar hyperglycemic syndrome is also known by many other names, including: Diabetic HHS. Diabetic hyperosmolar syndrome. Hyperglycemic hyperosmolar nonketotic coma (HHNK). Hyperosmolar coma.
What is the meaning of HHS in medical terms?
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. Buildup of ketones in the body (ketoacidosis) may also occur. But it is unusual and is often mild compared with diabetic ketoacidosis.
What is hyperglycemic hyperosmolar syndrome (HHS)?
Symptoms of HHS can include extreme thirst, frequent urination, changes in your vision and confusion. HHS is an emergency and you should contact your healthcare provider immediately if you have these symptoms. What is hyperosmolar hyperglycemic syndrome (HHS)? Hyperosmolar hyperglycemic syndrome (HHS) is a serious complication of diabetes mellitus.
What are the symptoms of HHS?
Pathophysiology HHS is usually precipitated by an infection, myocardial infarction, stroke or another acute illness. A relative insulin deficiency leads to a serum glucose that is usually higher than 33 mmol/L (600 mg/dL), and a resulting serum osmolarity that is greater than 320 mOsm.
What is the pathophysiology of HHS?
What are the symptoms of HHS?
Possible signs and symptoms include:Blood sugar level of 600 milligrams per deciliter (mg/dL) or 33.3 millimoles per liter (mmol/L) or higher.Excessive thirst.Dry mouth.Increased urination.Warm, dry skin.Fever.Drowsiness, confusion.Hallucinations.More items...•
What is the treatment for HHS?
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.
What is the cause of HHS?
Symptoms and Causes 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).
Is HHNS life threatening?
Hyperosmolar hyperglycemic state is a life-threatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. Although there are multiple precipitating causes, underlying infections are the most common.
Does HHS need insulin?
HHS occurs in patients with enough insulin to prevent ketoacidosis, but not enough insulin to control hyperglycemia.
Do you give insulin in HHS?
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.
When do you suspect HHS?
The hyperglycaemic complications of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) can be life-threatening and require emergency hospital admission if suspected. Polydipsia and polyuria. Weight loss. Abdominal pain, nausea and/or vomiting.
Can you have HHS without diabetes?
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.
How is HHNS diagnosed?
Diagnosis. 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.
What happens if HHS goes untreated?
Untreated high blood sugar can be dangerous, leading to a serious condition in diabetics called ketoacidosis. Chronic high blood sugar increases the likelihood of serious diabetes complications like heart disease, blindness, neuropathy, and kidney failure.
What is the difference between HHS and HHNS?
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. HHNS can happen to anyone, but it's more common in older people who have type 2 diabetes.
Which is worse DKA or HHS?
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 HHS and DKA treated?
Early diagnosis and management is paramount to improve patient outcomes. The mainstays of treatment in both DKA and HHS are aggressive rehydration, insulin therapy, electrolyte replacement, and discovery and treatment of underlying precipitating events.
Why do you give fluids in HHS?
Aggressive fluid resuscitation is key in the treatment of HHS. This is to avoid cardiovascular collapse and to perfuse vital organs. Fluid deficits in adults are large in HHS, being about 9 L on average.
Which is worse DKA or HHS?
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%.
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 HSS?
HSS is caused by mutations in the DKC1 gene (Xq28), encoding the nucleolar protein dyskerin which interacts with the human telomerase RNA complex. Mutations in other genes ( TERT, RTEL1 or TINF2, ACD, PARN) involved in telomere maintenance may be associated with this disorder.
What do healthcare professionals look for in a diagnosis?
Healthcare professionals typically look at a person’s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition.
What is the HPO database?
People with the same disease may not have all the symptoms listed. This information comes from a database called the Human Phenotype Ontology (HPO) . The HPO collects information on symptoms that have been described in medical resources. The HPO is updated regularly.
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 ...
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.
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.
Is HHS more common in type 2 diabetes?
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:
What is the HHS?
Hyperosmolar Hyperglycemic State (HHS) Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. It most often occurs in type 2 diabetes, often in the setting of physiologic stress.
What is hyperosmolar hyperglycemic state?
Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. It most often occurs in type 2 diabetes, often in the setting of physiologic stress. Hyperosmolar hyperglycemic state is diagnosed by severe hyperglycemia ...
What are the complications of hyperglycemic state?
Complications include coma, seizures, and death. (See also Diabetes Mellitus and Complications of Diabetes Mellitus .) Hyperosmolar hyperglycemic state (previously referred to as hyperglycemic hyperosmolar nonketotic coma [HHNK] and nonketotic hyperosmolar syndrome [NKHS]) is a complication of type 2 diabetes mellitus and has an estimated mortality ...
Why do older people get HHS?
This condition—and the enormous dehydration that accompanies it—occurs most often in older persons with type 2 diabetes. Patients are likely to develop HHS if they forget to take their medicines or develop an underlying illness.
Why are HHS patients admitted to the ICU?
Patients with HHS are usually admitted to the hospital’s intensive care unit ( ICU) because they must be watched very closely as they recover. Once the patient’s blood glucose levels improve and they are properly rehydrated, patients will be transitioned back to a regular diabetes treatment regimen to be taken at home.
How to know if you have high blood glucose?
Patients with HHS have extremely high blood glucose levels, often over 600 mg/dl. If you notice any of these signs or symptoms, seek prompt medical attention: 1 Dry mouth 2 Fast heart rate 3 Feeling thirsty 4 Urinating often 5 Nausea, vomiting, or stomach ache 6 Mental changes including confusion, slurred speech, or weakness on one side of the body (similar to the symptoms of a stroke)
What is the HHS?
Hyperosmolar hyperglycemic state ( HHS) is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Onset is typically over days to weeks.
How long does it take to fix HHS?
People with HHS can be dehydrated by 8 to 12 liters. Attempts to correct this usually take place over 24 hours with initial rates of normal saline often in the range of 1 L/h for the first few hours or until the condition stabilizes.
What causes high blood glucose levels?
HHS is usually precipitated by an infection, myocardial infarction, stroke or another acute illness. A relative insulin deficiency leads to a serum glucose that is usually higher than 33 mmol/L (600 mg/dL), and a resulting serum osmolarity that is greater than 320 mOsm. This leads to excessive urination (more specifically an osmotic diuresis ), which, in turn, leads to volume depletion and hemoconcentration that causes a further increase in blood glucose level. Ketosis is absent because the presence of some insulin inhibits hormone-sensitive lipase -mediated fat tissue breakdown .
Is metabolic acidosis more common in DKA or HHS?
Metabolic acidosis is absent or mild. A temporary state of confusion (delirium) is also more common in HHS than DKA. HHS also tends to affect older people more. DKA may have fruity breath, and rapid and deep breathing.
Is DKA more common in type 1 diabetics than HHS?
DKA usually occurs in type 1 diabetics whereas HHS is more common in type 2 diabet ics. DKA is characterized by a rapid onset, and HHS occurs gradually over a few days. DKA also is characterized by ketosis due to the breakdown of fat for energy.
How does hyperosmolar syndrome affect the body?
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.
How to prevent hyperosmolar syndrome?
Good daily control of your diabetes can help you prevent diabetic hyperosmolar syndrome. Know the symptoms of high blood sugar. Be alert for the warning symptoms of high blood sugar, as well as the situations that put you at risk of developing hyperosmolar syndrome, such as illness or infections. Monitor your blood sugar level.
How long does it take for hyperosmolar syndrome to develop?
Diabetic hyperosmolar syndrome can take days or weeks to develop. Possible signs and symptoms include: Blood sugar level of 600 milligrams per deciliter (mg/dL) or 33.3 millimoles per liter (mmol/L) or higher. Excessive thirst. Dry mouth.
What is the name of the condition that causes high blood sugar levels?
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.
What causes a person to have a hus?
In many cases, HUS is caused by infection with certain strains of Escherichia coli (E. coli) bacteria. The first symptom of this form of HUS is several days of diarrhea, which is often but not always bloody. HUS may also be caused by other infections, certain medications or conditions such as pregnancy, cancer or autoimmune disease.
What causes HUS?
The majority of HUS cases are caused by infection with certain strains of E. coli bacteria. Exposure to E. coli can occur when you: Eat contaminated meat or produce. Swim in pools or lakes contaminated with feces. Have close contact with an infected person, such as within a family or at a child care center.
What is the condition that can occur when the small blood vessels in your kidneys become damaged and inflamed?
Hemolytic uremic syndrome (HUS) is a condition that can occur when the small blood vessels in your kidneys become damaged and inflamed. This damage can cause clots to form in the vessels. The clots clog the filtering system in the kidneys and lead to kidney failure, which could be life-threatening.
What causes a hus to turn pink?
Fever. All forms of HUS — no matter the cause — damage the blood vessels. This damage causes red blood cells to break down (anemia), blood clots to form in the blood vessels and kidney damage. Signs and symptoms of these changes include: Pale coloring, including loss of pink color in cheeks and inside the lower eyelids.
How do you know if you have a hus infection?
Symptoms. The signs and symptoms of HUS may vary, depending on the cause. Most cases of HUS are caused by infection with certain strains of E. coli bacteria, which first affect the digestive tract. The initial signs and symptoms of this form of HUS may include: Diarrhea, which is often bloody. Abdominal pain, cramping or bloating. Vomiting. Fever.
Why do I get HUS?
Causes. The most common cause of HUS — particularly in children under the age of 5 — is infection with certain strains of E. coli bacteria. E. coli refers to a group of bacteria normally found in the intestines of healthy humans and animals. Most of the hundreds of types of E. coli are normal and harmless.
Can HUS be a complication of pregnancy?
The use of certain medications, especially some of the medications used to treat cancer and some of the medications used to suppress the immune system of organ transplant recipients. Rarely, HUS may occur as a complication of pregnancy or health conditions such as autoimmune disease or cancer.
