What is HHS syndrome

Overview. Diabetic hyperosmolar (hi-pur-oz-MOE-lur) syndrome is a serious condition caused by extremely high blood sugar

Is HHS life threatening?

HHS can be fatal if it’s not treated. Rarely, HHS can affect children and young adults who have type 1 or type 2 diabetes, especially if they are obese. Very rarely, people who have not yet been diagnosed with diabetes can develop HHS.

Can you recover from HHS?

Patients with HHS are usually admitted to the hospital’s intensive care unit (ICU) because they must be watched very closely as they recover. Once the patient’s blood glucose levels improve and they are properly rehydrated, patients will be transitioned back to a regular diabetes treatment regimen to be taken at home.

What is the treatment for HHS?

Treatment of HHS Treatment is 0.9% (isotonic) saline solution at a rate of 15 to 20 mL/kg/hour, for the first few hours. After that, the corrected sodium should be calculated. If the corrected sodium is < 135 mEq/L (< 135 mmol/L), then isotonic saline should be continued at a rate of 250 to 500 mL/hour.

How does infection cause HHS?

An illness or infection can trigger HHS. Failure to monitor and manage blood glucose levels can also lead to HHS. Symptoms may develop slowly and increase over a period of days or weeks.

What is HHNS diabetes?

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. HHNS can happen to anyone, but it’s more common in older people who have type 2 diabetes.

What conditions contribute to HHNK?

A stressful event such as infection, heart attack, stroke, or recent surgery.
Heart failure.
Impaired thirst.
Limited access to water (especially in people with dementia or who are bedbound)
Older age.
Poor kidney function.
Poor management of diabetes, not following the treatment plan as directed.

What is the mortality rate for HHS?

The mortality rate for patients with HHS is between 10 and 20 percent, which is approximately 10 times higher than that for DKA [7]. The mortality rate for hyperglycemic crisis declined between 1980 and 2009 [8].

Can HHS cause seizures?

In more advanced HHS, presentation is more likely to be altered mental status, seizures and/or coma. Patients may also present with an underlying fever, a clue to an underlying infection.

Does HHS need ICU?

All patients diagnosed with HHS require hospitalization; virtually all need admission to a monitored unit managed by medicine, pediatrics, or the intensive care unit (ICU) for close monitoring. When available, an endocrinologist should direct the care of these patients.

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Can HHS lead to stroke?

Although DM is a well-recognized risk factor for atherosclerosis, type 2 DM patients that have suffered a HHS attacks are at an increased risk of developing ischemic stroke compared with those without HHS.

Are you Acidotic in HHS?

A wide anion gap can be observed in patients with HHS, reflecting mild metabolic acidosis. The mild acidosis in HHS is often multifactorial and results, in part, from the accumulation of minimal ketoacids in the absence of effective insulin activity.

Does HHS cause hypernatremia?

Hyperosmolar hyperglycemic state (HHS) is a disorder that occurs most frequently in type 2 diabetics and is associated with high mortality – up to 50%. Hypernatremia, when associated with HHS, worsens the prognosis.

What does it feel like when your blood sugar is too high?

High blood sugar (hyperglycemia) If your blood sugar level is too high, you may experience: Increased thirst. Frequent urination. Fatigue.

What foods bring down blood sugar fast?

Barley.
Whole wheat.
Oat bran and rice bran cereals.
Whole grain pasta.
Whole grain pumpernickel bread.
Sourdough bread.
Wheat tortilla.
Nuts and nut butters.

How can you bring your blood sugar down quickly?

whole grains.
fruits.
vegetables.
lean proteins.

Can Type 1 diabetics get HHS?

HHS is characterized by severe hyperglycemia and hyperosmolality without significant ketosis and acidosis. HHS has been frequently reported in adult patients with type 2 DM (T2DM), but other than at academic meetings, no pediatric cases with HHS have been reported in Japanese patients with type 1 DM (T1DM).

What is HHS vs DKA?

DKA is characterized by ketoacidosis and hyperglycemia, while HHS usually has more severe hyperglycemia but no ketoacidosis (table 1). Each represents an extreme in the spectrum of hyperglycemia.

How is HHNS diagnosed?

Diagnosis. 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.

Is dry mouth part of diabetes?

One of the most common symptoms of diabetes is dry mouth, or xerostomia. Dry mouth is a common symptom in both type 1 and type 2 diabetes. Not everyone with diabetes will experience it, though. You can also have dry mouth if you don’t have diabetes.

Which complication of diabetes can cause hypoglycemia unawareness?

If you are like approximately 40% of people with Type 1 diabetes, you probably have some degree of hypoglycemia unawareness. This is a complication of T1D during which patients experience severe low blood sugars but do not feel them.

Can undiagnosed diabetes cause seizures?

Diabetes is the most common cause of the seizures in patients with low blood glucose. The subsequent unconsciousness with ketosis acidosis and NKH coma are more common in clinical practice; however, high blood glucose can also lead to seizures, even status epilepticus without awareness.

Is HHS the same as honk?

Hperglycemic hyperosmolar state (HHS) previously known as hyperosmolar nonketotic (HONK) coma is a syndrome characterized by extreme elevations in serum glucose concentrations, hyperosmolality and dehydration without significant ketosis (1,2).

Why is there no ketoacidosis in HHS?

While DKA is a state of near absolute insulinopenia, there is sufficient amount of insulin present in HHS to prevent lipolysis and ketogenesis but not adequate to cause glucose utilization (as it takes 1/10 as much insulin to suppress lipolysis as it does to stimulate glucose utilization) (33,34).

How does HHS cause hyperkalemia?

Hypokalemia or hyperkalemia may be present. Commonly, at time of presentation of HHS, serum potassium may be elevated due to an extracellular shift caused by insulin deficiency. However, total body potassium is likely low regardless of its serum value. The average potassium deficit in normally about 300-600 mEq.

What is the sliding scale for insulin?

The term “sliding scale” refers to the progressive increase in pre-meal or nighttime insulin doses. The term “sliding scale” refers to the progressive increase in the pre-meal or nighttime insulin dose, based on pre-defined blood glucose ranges. Sliding scale insulin regimens approximate daily insulin requirements.

Can beta hydroxybutyrate be elevated in HHS?

DKA-HHS overlap Specifically, they may have a combination of: (1) Substantial ketoacidosis (e.g. beta-hydroxybutyrate >3 mM and substantial anion gap elevation) (2) Extreme hyperglycemia with marked hypertonicity (e.g., glucose >>1000 mg/dL or >>55 mM, with serum osmolality >> 320 mOsm)

When do you suspect HHS?

The hyperglycaemic complications of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) can be life-threatening and require emergency hospital admission if suspected. Polydipsia and polyuria. Weight loss. Abdominal pain, nausea and/or vomiting.

What causes osmotic diuresis?

Osmotic diuresis is caused by an excess of urinary solute, typically nonreabsorbable, that induces polyuria and hypotonic fluid loss. Osmotic diuresis can result from hyperglycemia (i.e., diabetic ketoacidosis), use of mannitol, increased serum urea, or administration of other hypertonic therapies.

What is osmotic diuresis in HHS?

Osmotic diuresis is increased urination due to the presence of certain substances in the fluid filtered by the kidneys. This fluid eventually becomes urine. The process of osmosis created by these substances cause additional water to come into the urine, increasing its amount.

What causes hyponatremia?

Hyponatremia is decrease in serum sodium concentration < 136 mEq/L (< 136 mmol/L) caused by an excess of water relative to solute. Common causes include diuretic use, diarrhea, heart failure, liver disease, renal disease, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH).