Table of Contents
How can you tell the difference between DKA and HHS?
The resolution of DKA is reached when the blood glucose is < 200 mg/dl, serum bicarbonate is ≥15 mEq/L, pH is >7.30 and anion gap is ≤12 mEq/L (17). HHS is resolved when serum osmolality is < 320 mOsm/kg with a gradual recovery to mental alertness.
Which is worse HHS or 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%.
Are HHS and HHNK the same?
Hyperosmolar hyperglycemic syndrome is also known by many other names, including: Diabetes-related HHS. Diabetes-related hyperosmolar syndrome. Hyperglycemic hyperosmolar nonketotic coma (HHNK).
Is there an anion gap in HHS?
The calculated anion gap in HHS is usually within normal limits (8-12 mmol/L). A wide anion gap can be observed in patients with HHS, reflecting mild metabolic acidosis.
Is the treatment for DKA and HHS the same?
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.
Can ketones be present in HHS?
HHS is a potentially life-threatening emergency Ketones develop when the blood glucose level is high due to lack of insulin which is needed to allow glucose to enter the cells for energy. Because people with Type 2 diabetes may still be producing some insulin, ketones may not be created.
Does HHS need insulin drip?
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 3 diagnostic criteria for DKA?
DIFFERENTIAL DIAGNOSIS Three key features of diabetic acidosis are hyperglycemia, ketosis, and acidosis. The conditions that cause these metabolic abnormalities overlap.
What anion gap is DKA?
In mild DKA, anion gap is greater than 10 and in moderate or severe DKA the anion gap is greater than 12. These figures differentiate DKA from HHS where blood glucose is greater than 600 mg/dL but pH is greater than 7.3 and serum bicarbonate greater than 15 mEq/L.
When do you stop IV insulin in HHS?
Once blood glucose concentration reaches 300 mg/dL, decrease the insulin infusion rate by 0.5-1.0 U/h. Add dextrose to the IV fluids. Do not discontinue the insulin drip. Continue IV insulin at a goal glucose level of 250-300 mg/dL until the patient becomes more alert and hyperosmolarity has resolved.
What is the difference between DKA and HHNS?
When your blood sugar is very high, ketones (acidic substances) can accumulate in your blood at dangerous levels, causing DKA. 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.
When to go to the ER for HHNS and DKA?
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 much insulin is given to children with diabetic ketoacidosis (DKA)?
Al Hanshi S, Shann F. Insulin infused at 0.05 versus 0.1 units/kg/hr in children admitted to intensive care with diabetic ketoacidosis. Pediatr Crit Care Med. 2011;12(2):137-140. 147.
Why is there a variability in the presentation of diabetic ketoacidosis (DKA)?
Because there is considerable individual variability in presentation of DKA (ranging from mild with only minimal dehydra- tion to severe with profound dehydration), some patients may require specific treatment that, in the judgment of the treating phy- sician, may be within or, occasionally, outside the range of options presented here.