Hyperosmolar Hyperglycemic Nonketotic Syndrome, or HHNS, is a serious condition most frequently seen in older persons. HHNS can happen. Hyperosmolar hyperglycemic state is a life-threatening emergency manifested by marked eleva- ADA = American Diabetes Association. Hyperosmolar hyperglycemic state is a life-threatening emergency on recommendations from the American Diabetes Association (Figure 2).

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The Journal of pediatrics ; Kaminska ES, Pourmotabbed G. Venous pH should be assessed htperosmolar 2 hours until the pH rises to 7. Review Management of decompensated diabetes. To prevent hypokalemia, potassium replacement is initiated after serum levels fall below 5. Kussmaul respiration, acetone breath, nausea, vomiting and abdominal pain may also occur primarily in DKA and are due to ketosis and acidosis.

Insulin substitution approach should be very conservative as it is expected that insulin resistance will improve with rehydration.

Hyperosmolar Hyperglycemic State

Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. In patients who are hypernatremic or eunatremic, 0. Children are at greater risk of developing potentially fatal cerebral edema during treatment. Treatment begins with intensive monitoring of the patient and laboratory values, especially glucose, sodium, and potassium levels. Vomiting and thiazide diuretics may cause a metabolic alkalosis that could mask the severity of acidosis.


Clinical and metabolic characteristics of hyperosmolar nonketotic coma. Sign up for a FREE trial. No relevant financial affiliations.

In this regard, it is important to distinguish ketosis and acidosis, as the two terms are not always synonymous in DKA. See My Options close. Serum bicarbonate level mEq per L.

BMJ Best Practice

Review Diabetic hyperodmolar and hyperglycemic hyperosmolar state. Children may present with nonspecific symptoms such as headache, weakness, and vomiting with or without abdominal pain. Take a look at our subscription options.

Journal of critical care ; Curr Ther Endocrinol Metab. For any urgent enquiries please contact our customer services team who are ready to help with any problems.

In this condition the plasma becomes milky and lipemia retinalis may be visible in physical examination An elevated C-reactive protein level is an early indicator of sepsis in patients with HHS. HHNS may take days or even weeks to develop. Hyperosmolar nature of diabetic coma. Qual Manag Health Care ; 6: In children and adolescents, hyperosmolar hyperglycemic state is often present when type 2 diabetes is diagnosed.


Nearly 30 million battle diabetes and every 23 seconds someone new is diagnosed. Recent advances in the monitoring and management of diabetic ketoacidosis.

Abdominal pain in diabetic metabolic decompensation. Hyperozmolar consists of the biochemical triad of hyperglycemia, ketonemia and hyperksmolar anion gap metabolic acidosis 12 Figure 2. Thrombotic adw and disseminated srate coagulation may contribute to the morbidity and mortality of hyperglycemic emergencies Want to use this article elsewhere? Diabetic acidosis with initial hypokalemia.

However, no controlled studies have shown improved outcomes with phosphate replacement. Clin Chem ; Adapted from Kitabchi et al. More recently, it has been proposed that consciousness level in adolescents with DKA was related to the severity of acidosis pH and not to a blood glucose levels Routine antibiotics are not recommended for all patients with suspected infection.

Am Fam Physician ; Physical findings include profound dehydration and neurologic symptoms ranging from lethargy to coma.