Explore
Hyperosmolar Hyperglycemic Nonketotic Syndrome. 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.
What is hyperosmolar Hyperglycemic Nonketotic Syndrome?
Definition of HHNS: a life-threatening condition of a hyperglycemic state that affects patients with diabetes mellitus. It presents with an extreme high blood glucose which causes the blood to become very concentrated “hyperosmolar” but without the breakdown of KETONES (fats)
What is HHNS (hyperglycemic hyperglycemic state)?
HHNS is sometimes referred to by other names: 1 Hyperglycemic hyperosmolar nonketotic coma (HHNK) 2 Nonketotic hyperosmolar syndrome (NKHS) 3 Diabetic hyperosmolar syndrome 4 Diabetic HHS 5 Hyperosmolar coma 6 Hyperosmolar hyperglycemic state
What are the other names for HHNS?
A very high blood sugar level (over 600 mg/dL) with low ketone levels (acids in blood and urine) will help the doctor make a diagnosis of HHS. How is hyperosmolar hyperglycemic syndrome (HHS) treated?
What blood sugar level indicates hyperosmolar hyperglycemic syndrome?
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.
What are the symptoms of hyperglycemic hyperosmolar 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 is the standard treatment for hyperosmolar hyperglycemic syndrome?
Hyperosmolar hyperglycemic state is diagnosed by severe hyperglycemia and plasma hyperosmolality and absence of significant ketosis. Treatment is IV saline solution and insulin. Complications include coma, seizures, and death.
How do you bring blood sugar down quickly?
When your blood sugar level gets too high — known as hyperglycemia or high blood glucose — the quickest way to reduce it is to take fast-acting insulin. Exercising is another fast, effective way to lower blood sugar....Eat a consistent dietwhole grains.fruits.vegetables.lean proteins.
How is hyperosmolar hyperglycemic state 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.
When do you suspect HHS?
Diagnosis of HHS Doctors suspect the diagnosis of hyperosmolar hyperglycemic state when people who have recently developed confusion are found to have a very high blood glucose level.
What are the diagnostic criteria for HHS?
Current diagnostic criteria of HHS recommended by the American Diabetes Association (ADA) and international guidelines include a plasma glucose level >600 mg/dL, plasma effective osmolarity >320 mOsm/L, and an absence of significant ketoacidosis (Table 2) (4,58,59).
What lab test confirms 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.
What happens to diabetics who get HHNS?
When HHNS affects a person with diabetes, blood sugar levels rise and the body passes excess sugar into the urine.
What causes HHNS?
Usually, HHNS is brought on by an illness or infection.
What is the best way for people with diabetes to avoid HHNS?
If you keep on top of your blood sugar levels, it is possible to avoid HHNS. By checking blood glucose regularly , people with diabetes can take action if a reading falls outside their target blood glucose range.
What are the symptoms of HHS?
What are the major warning signs of HHS for people with diabetes? 1 Dry mouth 2 Elevated blood sugar levels 3 Extreme thirst 4 Warm skin without sweat 5 Fever 6 Confusion or feeling sleepy 7 Vision loss 8 Hallucinations 9 Nausea 10 Weakness down one side of the body
Can period of illness cause hyperglycemia?
Periods of illness can significantly raise blood glucose levels, which could lead to Hyperosmolar Hyperglycaemic State (HHS) if medication is not sufficient to lower sugar levels.
Which type of diabetes is most affected by HHS?
HHS most often affects people who have type 2 diabetes who are:
How high is the blood sugar level for HHS?
Your doctor will examine you, ask about your symptoms, and order a blood test to check your blood sugar level. A very high blood sugar level (over 600 mg/dL) with low ketone levels (acids in blood and urine) will help the doctor make a diagnosis of HHS.
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 to reduce risk of HHS?
You can reduce your risk of developing HHS again by controlling your diabetes and managing your diet and lifestyle.
How many people die from HHS?
The outlook for patients who have HHS largely depends on the person’s age, general health and how severe the disease is. Up to 20% of people who have HHS die from the condition. If you’ve had HHS, you will need to work closely with your doctor once you are home from the hospital.
What is HHNS in diabetes?from verywellhealth.com
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.".
What is a HHNS?from verywellhealth.com
HHNS is a relatively rare complication of diabetes, accounting for just 1% of hospital admissions among people with diabetes. 1 . HHNS is sometimes referred to by other names: Hyperglycemic hyperosmolar nonketotic coma (HHNK) Nonketotic hyperosmolar syndrome (NKHS) Diabetic hyperosmolar syndrome. Diabetic HHS.
What happens to diabetics who get HHNS?from diabetes.co.uk
When HHNS affects a person with diabetes, blood sugar levels rise and the body passes excess sugar into the urine.
What is the best way for people with diabetes to avoid HHNS?from diabetes.co.uk
If you keep on top of your blood sugar levels, it is possible to avoid HHNS. By checking blood glucose regularly , people with diabetes can take action if a reading falls outside their target blood glucose range.
What is the pathophysiology of HHS and DKA?from ncbi.nlm.nih.gov
HHS has similar pathophysiology to DKA but with some mild dissimilarities. The hallmark of both conditions is the deficiency of insulin. As a consequence of deficiency of this key hormone, there is a decrease in glucose utilization by the peripheral tissue causing hyperglycemia.[19] The peripheral tissues enter a state of “starvation”.The release of counterregulatory hormones like the glucagon, growth hormone, cortisol, and catecholamines stimulates gluconeogenesis and glycogenolysis. [19][20] This creates a system of vicious cycle where there is an increased level of glucose in the serum but decreased uptake by the peripheral tissues for tissue metabolism. The serum osmolality is determined by the formula 2Na + Glucose /18 + BUN / 2.8. The resultant hyperglycemia increases the serum osmolarity to a significant degree. The glucose level in HHS is usually above 600 mg/dL. Hyperglycemia also creates an increase in the osmotic gradient with free water drawn out of the extravascular space due the increased osmotic gradient. Free water with electrolytes and glucose is lost via urinary excretion producing glycosuria causing moderate to severe dehydration. Dehydration is usually more severe in HHS as compared to DKA, and there is more risk for cardiovascular collapse. [21][22][23][24]
What is the HHS level?from ncbi.nlm.nih.gov
According to the recommendation of the American Diabetic Association and current international guideline, HHS is defined by plasma glucose level greater than 600 mg/dL, plasma effective osmolarity greater than 320 mOsm/L, and absence of significant ketoacidosis. [28]
Why does HHNS happen?from verywellhealth.com
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 .
What is hyperosmolar hyperglycemic nonketotic syndrome?
Your blood carries the glucose to the cells of your body. An organ in your upper belly, called the pancreas, makes and releases a hormone called insulin when it detects glucose. Your body uses insulin to help move the glucose from the bloodstream into the cells for energy. When your body does not make insulin (type 1 diabetes), or has trouble using insulin (type 2 diabetes), glucose cannot get into your cells. The glucose level in your blood goes up. Too much glucose in your blood (also called hyperglycemia or high blood sugar) can cause many problems.
What is HHNS in kidneys?
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.
What is it called when your blood sugar goes up?
The glucose level in your blood goes up. Too much glucose in your blood (also called hyperglycemia or high blood sugar) can cause many problems. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome (HHNS). It is very rare in people with type 1 diabetes.
How long do you stay in the hospital with HHNS?
A healthy person with no medical problems other than diabetes and no HHNS complications may stay in the hospital 3 to 5 days. You may be in an intensive care unit at the hospital for at least the first day or two. A person with other medical problems or HHNS complications may need to stay in the hospital much longer.
How to treat HHNS?
Treatment. The treatment for HHNS depends on the cause and how well you respond to treatment. The goal of treatment is to return your blood sugar to a normal level and keep it in a normal range. Treatment may include: You will have a small tube (IV catheter) inserted into a vein in your hand or arm.
Can HHNS cause death?
The imbalance of fluids, glucose, and minerals in the body can lead to severe problems, such as brain swelling, abnormal heart rhythms, seizures, coma, or organ failure. Without rapid treatment, HHNS can cause death.
What is Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)?
HHNS, also known as a hyperosmolar hyperglycemic nonketotic syndrome (HHNS), is a rare but serious complication of diabetes mellitus. HHS can cause life-threatening dehydration, electrolyte and acid/base imbalances, and coma.
What are the symptoms of hyperglycemic nonketotic syndrome?
The hyperglycemic hyperosmolar syndrome symptoms include frequent or deep, rapid breathing, lethargy, and confusion, changes in the level of consciousness (LOC), seizures, and coma. Patients with hyperosmolar hyperglycemic nonketotic syndrome are often found to have serum glucose greater than 600mg/dL. Although the exact cause is unknown, it is believed that a combination of dehydration and hyperglycemia causes osmotic diuresis resulting in symptoms.
What is HHNS in medical terms?
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is a life-threatening medical emergency when the body cannot produce or use insulin. The condition can be caused by cancer, diabetes, kidney failure, and other chronic conditions.
What are the clinical features of HHNS?
The clinical features of HHNS include severe dehydration, hyperglycemia, and altered mental status. These symptoms can be caused by excessive release of ADH leading to inappropriate retention of water in the kidney tubules. This results in a reduced effective circulating volume, the increased osmolality of the blood and extracellular fluid (ECF), and decreased blood flow to the brain. It can also cause volume depletion in other organs, such as the gastrointestinal tract.
When should HHNS be observed?
A person with HHNS should be observed until their serum glucose level returns to normal. Evaluating fluid and electrolyte imbalances is also necessary to ensure that clients do not experience further complications.
How to diagnose HHNS?
To confirm a diagnosis of HHNS, clinicians look for at least one of two diagnoses: exaggerated increase in ADH concentration or an inability to excrete free water.
Why is hypertonic glucose infusion controversial?
The use of a hypertonic glucose infusion is controversial because it may increase brain edema. Still, its use should be considered if there are any signs or symptoms of increased cerebral edema.
Why is there no ketosis in HHNS?
Important take-aways: NO KETOSIS or ACIDOSIS in HHNS because there is just enough insulin present that prevents the body from breaking down fats for energy; therefore there is no build-up of ketones.
What is HHNS in medical terms?
A.K.A: Hyperosmolar Hyperglycemic State (HHS) Definition of HHNS: a life-threatening condition of a hyperglycemic state that affects patients with diabetes mellitus. It presents with an extreme high blood glucose which causes the blood to become very concentrated “hyperosmolar” but without the breakdown of KETONES (fats)
What is HHNS in nursing?
NCLEX review on Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) for nursing lecture exams and the NCLEX exam. HHNS is a life-threatening condition of diabetes mellitus.
Why is GLUCOSE not able to enter the cell?
Insulin: helps take glucose into the cell so the body can use it for fuel. In HHNS, the cells are not receptive to the insulin or there isn’t enough because of an illness which limits its availability. Therefore, GLUCOSE can NOT enter into the cell and glucose floats around in the blood.
Why is glucose not used in the body?
Glucose: fuels the cells so they can function. However, the body is not using the glucose because there isn’t enough insulin to take it into the cell or the cells are insulin RESISTANT. Glucose levels will >600 mg/dL. The blood becomes very concentrated a.k.a. “hyperosmolar” due to the extra glucose. This causes water to pull from inside the cells which will result in cell dehydration and an even higher glucose level.
Why does blood have a high glucose level?
“hyperosmolar” due to the extra glucose. This causes water to pull from inside the cells which will result in cell dehydration and an even higher glucose level. Insulin: helps take glucose into the cell so the body can use it for fuel.
Why is blood glucose high in older adults?
Illness or infection (the patient isn’t aware their blood glucose is high because they haven’t been monitoring it )…most common in OLDER ADULTS
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.
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).
Is HHS a serious complication?
HHS is a serious and potentially fatal complication of type 2 diabetes.
Where is the 2Icahn School of Medicine?
2Icahn School of Medicine at Mount Sinai , The Brooklyn Hospital Center
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.
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.
How many steps are there for HHNS?
A medical professional can typically treat HHNS using four steps:
Is DKA the same as HHNS?
Your treatment for DKA is similar to that of HHNS. The medical professional will:
Can you prevent HHNS?
While you might not always be able to prevent some causes of HHNS or DKA, like an illness or infection, there are steps you can take to reduce the risk of these conditions occurring. These include:
Is HHNS a life threatening condition?
While HHNS and D KA are serious medical conditions that can lead to life threatening complications, they are preventable and treatable, especially if you identify them early.
