Can you have DKA and HHS at the same time?

Both DKA and HHS are characterized by hyperglycemia and absolute or relative insulinopenia. Clinically, they differ by the severity of dehydration, ketosis and metabolic acidosis (11). DKA most often occurs in patients with type 1 diabetes mellitus (T1DM).

Correspondingly, what is the difference between HHS and DKA?

Although both conditions can occur at any age, diabetic ketoacidosis typically develops in younger patients, less than 45 years, who have little or no endogenous insulin production, whereas HHS usually occurs in much older non-insulin-dependent patients (who are often greater than 60 years old).

Beside above, can HHS lead to DKA? PRECIPITATING CAUSES In patients with established diabetes, precipitating factors for DKA include infections, intercurrent illnesses, psychological stress, and poor compliance with therapy. Most patients with HHS have type 2 diabetes. HHS is the initial manifestation of diabetes in 7–17% of patients.

Additionally, is DKA or HHS worse?

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%. HHS is characterized by hyperglycemia, hyperosmolarity, and dehydration without significant ketoacidosis.

Why does HHS have a higher mortality rate than DKA?

Overall mortality for HHS is estimated at 5-20% and is usually due to the underlying illness that caused the hyperglycemic crisis. Prognosis is worse for elderly patients and patients in whom coma and hypotension are found. This is in contrast to the mortality rate of DKA, which is estimated to be about 1-5%.

Which condition is seen in a patient with hyperosmolar hyperglycemic syndrome HHS?

Hyperosmolar Hyperglycemic State (HHS) Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus (DM) characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. It most often occurs in type 2 DM, often in the setting of physiologic stress.

What causes hyperosmolar hyperglycemic state?

Causes. Also, certain drugs, such as corticosteroids, can raise blood glucose levels and cause hyperosmolar hyperglycemic state. Drugs such as diuretics, which people often take to treat high blood pressure, can worsen dehydration and trigger hyperosmolar hyperglycemic state.

How long does it take DKA to develop?

SIGNS AND SYMPTOMS DKA can develop in less than 24 hours. 3 Metabolic changes occur one and one half to two hours earlier in patients who are managed only with a short-acting insulin such as lispro (Humalog).

Why are there no ketones 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.

Why is the anion gap important to follow in the treatment of DKA?

Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia.

How do you treat HHS?

Treatment

Intravenous fluids to counter dehydration.
Intravenous insulin to lower your blood sugar levels.
Intravenous potassium, and occasionally sodium phosphate replacement to help your cells function correctly.

What does hyperosmolar mean?

Medical Definition of Hyperosmolar Hyperosmolar: In biochemistry, pertaining to an osmolar concentration of the body fluids that is abnormally increased.

What is HHS syndrome?

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.

How is hyperosmolar hyperglycemic state diagnosed?

What are the ADA diagnostic criteria for hyperosmolar hyperglycemic state (HHS)?

Plasma glucose level of 600 mg/dL or greater.
Effective serum osmolality of 320 mOsm/kg or greater.
Profound dehydration, up to an average of 9 L.
Serum pH greater than 7.30.
Bicarbonate concentration greater than 15 mEq/L.

What is Kussmaul breathing?

Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure. It is this latter type of breathing pattern that is referred to as Kussmaul breathing.

What is the opposite of DKA?

Despite the similarity in name, ketosis and ketoacidosis are two different things. Ketoacidosis refers to diabetic ketoacidosis (DKA) and is a complication of type 1 diabetes mellitus. It's a life-threatening condition resulting from dangerously high levels of ketones and blood sugar.

What is hyperglycemic crisis?

Hyperglycemic crisis is a metabolic emergency associated with uncontrolled diabetes mellitus that may result in significant morbidity or death. Acute interventions are required to manage hypovolemia, acidemia, hyperglycemia, electrolyte abnormalities, and precipitating causes.

How rapidly is fluid volume replaced in DKA?

Fluid loss averages approximately 6–9 L in DKA. The goal is to replace the total volume loss within 24–36 hours with 50% of resuscitation fluid being administered during the first 8–12 hours.

How do you get diabetic ketoacidosis?

Diabetic ketoacidosis (DKA) is a life-threatening problem that affects people with diabetes. It occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic.

Why does HHS cause dehydration?

It's often triggered by illness or infection. As a result of 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.

Why is DKA more common in type 1?

What Causes DKA? It usually happens because your body doesn't have enough insulin. Your cells can't use the sugar in your blood for energy, so they use fat for fuel instead. People with type 1 diabetes are at risk for ketoacidosis, since their bodies don't make any insulin.