Hyperosmolar coma is also referred to as hyperosmolar hyperglycemic syndrome (HHS) or nonketotic hyperglycemic syndrome. It is characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of significant ketoacidosis. Hyperosmolar coma and diabetic ketoacidosis (DKA) are hyperglycemic crises.

What does it mean to be hyperosmolar?

The loss of water also makes the blood more concentrated than normal. This is called hyperosmolarity. It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances. This draws the water out of the body’s other organs, including the brain.

What happens when you have hyperosmolar?

Hyperosmolar hyperglycemic syndrome (HHS) is a serious complication of diabetes mellitus. HHS occurs when a person’s blood glucose (sugar) levels are too high for a long period, leading to severe dehydration (extreme thirst) and confusion.

What causes hyperosmolar coma?

Diabetic hyperosmolar (hi-pur-oz-MOE-lur) syndrome is a serious condition caused by extremely high blood sugar levels. The condition most commonly occurs in people with type 2 diabetes. It’s often triggered by illness or infection.

How is hyperosmolar coma treated?

  1. Fluids given through a vein (intravenously) to treat dehydration.
  2. Insulin given through a vein (intravenously) to lower your blood sugar levels.
  3. Potassium and sometimes sodium phosphate replacement given through a vein (intravenously) to help your cells function correctly.

How is hyperosmolar hyperglycemic state diagnosed?

Hyperosmolar hyperglycemic state is diagnosed by blood tests that show very high levels of glucose and very concentrated blood. Treatment is intravenous fluids and insulin. Complications include coma, seizures, and death.

Is DKA or HHS worse?

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%.

Which medications may induce diabetes?

  • Corticosteroids.
  • Thiazide diuretics.
  • Beta-blockers.
  • Antipsychotics.
  • Statins.

What are the symptoms of hyperosmolar nonketotic coma?

  • Blood glucose levels over 600 milligrams per deciliter (mg/dl)
  • Frequent urination.
  • Extreme thirst.
  • Dry mouth.
  • Confusion or sleepiness.
  • Skin that is warm and dry without sweating.
  • Fever (usually over 101 F)
  • Weakness or paralysis on one side of the body.
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.

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What is the usual treatment procedure for correction of 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 do you manage a honk?

Treatment for HONK Treatment for hyperglycaemic hyperosmolar non-ketotic coma will include fluids being given to the patient and insulin administered intravenously.

What are the 4 most common leading complications of diabetes?

  1. Heart disease. A diabetic has twice a non-diabetic’s likelihood of dying of heart disease, including stroke. …
  2. Foot problems. Diabetes reduces circulation. …
  3. Kidney disease. Diabetes is the foremost cause of kidney disease. …
  4. Eye problems.

What happens during diabetic coma?

In a diabetic coma, you are unconscious and unable to respond to your environment. You are either suffering from high blood glucose (hyperglycemia) or low blood glucose (hypoglycemia). You need immediate medical attention if you go into a diabetic coma.

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].

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.

Which patient complaint is associated with syndrome of inappropriate antidiuretic?

A low sodium level or hyponatremia is a major complication of SIADH and is responsible for many of the symptoms of SIADH. Early symptoms may be mild and include cramping, nausea, and vomiting. In severe cases, SIADH can cause confusion, seizures, and coma.

What is considered severe hyperglycemia?

Hyperglycemic hyperosmolar state. Blood glucose levels may become very high — greater than 1,000 mg/dL (55.6 mmol/L). Because insulin is present but not working properly, the body can’t use either glucose or fat for energy. Glucose is then spilled into the urine, causing increased urination.

How does DKA happen?

DKA happens when the signal from insulin in the body is so low that: Glucose (blood sugar) can’t go into cells to be used as a fuel source. The liver makes a huge amount of blood sugar. Fat is broken down too rapidly for the body to process.

What medications should diabetics avoid?

  • Azole antifungals.
  • Certain antibiotics, including rifampin and isoniazid.
  • Some high blood pressure medicines, such as calcium channel blockers, beta-blockers, and thiazide diuretics.
  • Corticosteroids.
  • Estrogen.
  • Nicotinic acid.
  • Oral contraceptives.
  • Phenothiazines.

What is the best antidepressant for diabetics?

In diabetic neuropathy without depression, the best choices among non-TCAs may include sertraline, citalopram, and perhaps, venlafaxine, since the TCAs appear to increase cravings and increase FBG levels.

Are statins good for diabetics?

The ADA recommends a moderate statin dose for people with diabetes who are under 40, or 40 to 75 without any other risks for heart disease. A high statin dose is recommended for people with diabetes who have heart disease, and for those between 40 and 75 who have other risk factors for heart disease.

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.

Why is HHS altered mental status?

Patients with HHS can present with altered mental status as a result of significant fluid depletion and decreased cerebral perfusion.

Can HHS cause fever?

Physical findings in patients with HHS include profound dehydration with poor tissue turgor; dry buccal mucosa; soft, sunken eyeballs; cool extremities; and a rapid, thready pulse. 19 Adults often present with a low-grade fever.

Is HHS 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).

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.

When was Honk the musical written?

Since it first hatched in 1993, Stiles & Drewe’s musical, Honk!, has winged its way around the world in over 8,000 productions and in many different languages.

What is the number one cause of death for diabetics?

Cardiovascular disease could be the most common cause of death in diabetic patients, followed by cancer.

What is a diabetic belly?

Diabetic gastroparesis refers to cases of the digestive condition gastroparesis that diabetes causes. During normal digestion, the stomach contracts to help break down food and move it into the small intestine. Gastroparesis disrupts the stomach’s contraction, which can interrupt digestion.

What are 10 warning signs of diabetes?

  • Frequent urination. When your blood sugar is high, your kidneys expel the excess blood sugar, causing you to urinate more frequently. …
  • Increased thirst. …
  • Fatigue. …
  • Blurred vision. …
  • Increased hunger. …
  • Unexplained weight loss. …
  • Slow healing cuts and wounds. …
  • Tingling or numbness in the hands or feet.