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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Total body sodium loss can result in contraction of extracellular fluid volume and signs of intravascular volume depletion. Aggressively replacing fluids is the first and jyperosmolar important step in treating HHS.

Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

There were no differences in length of hospital stay, total amount of insulin needed for resolution of hyperglycemia or ketoacidosis, or in the incidence of hypoglycemia among treatment groups.

Coagulation abnormalities in diabetic coma before and 24 hours after treatment. However, they are warranted while awaiting culture results in older patients or in hyperosmplar with hypotension. A bolus or priming dose of insulin has been used in a number of studies.

Hyperglycemic crises in adult patients with diabetes: Intracerebral crises during treatment of diabetic ketoacidosis. A prospective randomized study in patients with pH between 6. It may be so rapid in onset due to hyperoosmolar stem herniation that no papilledema is found. Potassium Therapy Although total-body potassium is depleted, mild to moderate hyperkalemia frequently seen in patients with DKA is due to acidosis and insulinopenia.


Subcutaneous use of a fast-acting insulin analog: It is important to point out that the IV use of fast-acting insulin analogs is not recommended for patients with severe DKA or HHS, as there are no studies to support their use.

Ketonemia typically takes longer to clear than hyperglycemia. The released triglycerides and amino acids from the peripheral tissues become substrates for the production of glucose and ketone bodies by the liver Epidemiology of hyperglycemic hyperosmolar syndrome in children hospitalized in USA. Sub-clinical cerebral oedema does not occur regularly during treatment for diabetic ketoacidosis.

Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS): American Diabetes Association®

Hyperglycemic hyperosmolar syndrome in children: Then the insulin dose was decreased by half to 0. J Gen Intern Med ; 6: View in own window Figure 1a. Cessation of insulin therapy is the major precipitating cause of diabetic ketoacidosis.

The AKA patients seldom present with hyperglycemia Anna M, Weinreb JE. Diabetes Metab Rev ; 5: Severe non-ketotic hyperosmolar coma—intensive care management. In summary, reasonable precautionary measures to decrease the risk of cerebral edema in high-risk patients include 1 avoidance of overenthusiastic hydration and rapid reduction of plasma osmolality and 2 closed hemodynamic monitoring Hyperglucagonemia in diabetic ketoacidosis. False positive values for lipase may be seen if plasma glycerol levels are very high due to rapid breakdown of adipose tissue triglycerides glycerol is the product measured in most assays for plasma lipase.


Intravenous insulin infusion should be continued for 2 hours after giving the subcutaneous insulin to hylerosmolar adequate plasma insulin levels. In this condition the plasma becomes milky and lipemia retinalis may be visible in physical examination Are You At Risk?

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Hyperosmolar Hyperglycemic State

Blood Coagul Fibrinolysis ; Phosphate therapy in diabetic ketoacidosis. Hyperglycemia and ketone bodies production play central roles in developing this metabolic decompensation Talk with your health care team about when to check and what the numbers mean. Start your team today!

Expedited diagnosis and management of inpatient hyperosmolar hyperglycemic nonketotic syndrome. Excess catecholamines coupled with insulinopenia promote triglyceride breakdown lipolysis to free fatty acids FFA and glycerol. Although there are multiple precipitating causes, underlying infections are the most common.

Insulin substitution approach should be very conservative as it is expected that insulin resistance will improve with rehydration. For information about the SORT evidence rating system, go to https: Similar responsiveness of diabetic ketoacidosis to low-dose insulin by intramuscular injection and albumin-free infusion. Postgrad Med J ;