What do you need to know as a nurse about DKA/HHNS?
As the nurse, you must know typical signs and symptoms of DKA and HHNS, patient teaching, and expected medical treatments. Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) are both complication of diabetes mellitus, but there are differences between the two complications that you must know as a nurse.
Can HHNS and DKA be prevented?
While HHNS and DKA are serious medical conditions that can lead to life threatening complications, they are preventable and treatable, especially if you identify them early. Following a treatment plan, staying hydrated, and monitoring your body for any unusual symptoms can all help reduce your risk of developing these conditions.
What is the difference between HHS and 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.
What is diabetic ketoacidosis (DKA) and hyperglycemic non-keto acidosis (hhnk)?
Diabetics Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic Non-Ketoacidosis (HHNK) is the type of medical emergencies that are observed in the diabetic patient. Both of them are a life-threatening disease which keeps patient lives in danger.
How do you treat DKA and HHS?
The mainstays of treatment in both DKA and HHS are aggressive rehydration, insulin therapy, electrolyte replacement, and discovery and treatment of underlying precipitating events.
How is HHNS treated?
Treatment typically includes:Fluids given through a vein (intravenously) to treat dehydration.Insulin given through a vein (intravenously) to lower your blood sugar levels.Potassium and sometimes sodium phosphate replacement given through a vein (intravenously) to help your cells function correctly.
What is the primary treatment for DKA?
The major treatment of this condition is initial rehydration (using isotonic saline) with subsequent potassium replacement and low-dose insulin therapy. The use of bicarbonate is not recommended in most patients.
Do you give insulin for HHNS?
Once dehydration is partially corrected, adults should receive an initial bolus of 0.1 units of intravenous insulin per kg of body weight, followed by a continuous infusion of 0.1 units per kg per hour (or a continuous infusion of 0.14 units per kg per hour without an initial bolus) until the blood glucose level ...
How is DKA treated in adults?
Treatment usually involves:Fluid replacement. You'll receive fluids — either by mouth or through a vein — until you're rehydrated. ... Electrolyte replacement. Electrolytes are minerals in your blood that carry an electric charge, such as sodium, potassium and chloride. ... Insulin therapy.
What is HHS in medicine?
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.
Why is insulin used to treat DKA?
Insulin administration is essential in DKA treatment because it promotes glucose utilization by peripheral tissues, diminishes glycogenolysis and gluconeogenesis, and suppresses ketogenesis.
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. The precipitating factors, clinical features, evaluation, and diagnosis of DKA and HHS in adults will be reviewed here.
When do you give insulin for DKA?
The half-life of regular insulin is less than 10 minutes. Therefore, to avoid relapse of diabetic ketoacidosis, the first subcutaneous dose of regular insulin should be given at least one hour before intravenous insulin is discontinued.
Does HHS need insulin?
HHS occurs in patients with enough insulin to prevent ketoacidosis, but not enough insulin to control hyperglycemia.
What is DKA medical?
Diabetic ketoacidosis (DKA) is a serious complication of diabetes that can be life-threatening. DKA is most common among people with type 1 diabetes. People with type 2 diabetes can also develop DKA. DKA develops when your body doesn't have enough insulin to allow blood sugar into your cells for use as energy.
How do you manage 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.
What is the quiz on DKA vs HHNS?
This quiz on DKA vs HHNS ( Diabetic Ketoacidosis vs Hyperglycemic Hyperosmolar Nonketotic Syndrome) will test you on how to care for the diabetic patient who is experiencing these conditions. As the nurse, you must know typical signs and symptoms of DKA and HHNS, patient teaching, and expected medical treatments.
Why is osmotic diuresis present in HHNS and DKA?
True or False: Osmotic diuresis is present in HHNS and DKA due to the kidney’s inability to reabsorb the excessive glucose which causes glucose to leak into the urine which in turn causes extra water and electrolytes to be excreted. 8.
Is HHNS a complication of diabetes mellitus?
Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) are both complication of diabetes mellitus, but there are differences between the two complications that you must know as a nurse.
What is the difference between DKA and HHS?
INTRODUCTION Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS, also known as hyperosmotic hyperglycemic nonketotic state [HHNK]) are two of the most serious acute complications of diabetes. 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. The precipitating factors, clinical features, evaluation, and diagnosis of DKA and HHS in adults will be reviewed here. The epidemiology, pathogenesis, and treatment of these disorders are discussed separately. DKA in children is also reviewed separately. (See "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis".) Continue reading >>
What is DKA in the body?
DKA is characterized by hyperglycemia, ketone body formation and metabolic acidosis. Precipitating causes are usually infection or insulin omission. Over the past 20 years, there has been no reduction in the DKA mortality rates, which remain between 3.4% and 4.6%.
What is the most serious metabolic disorder in diabetes mellitus?
Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the two most serious metabolic complications of diabetes mellitus (DM). These disorders can occur in both type 1 and type 2 DM. DKA is characterized by hyperglycemia, ketone body formation and metabolic acidosis.
What is the hallmark of diabetes?
The hallmark of diabetes is a raised plasma glucose resulting from an absolute or relative lack of insulin action. Untreated, this can lead to two distinct yet overlapping life-threatening emergencies. Near-complete lack of insulin will result in diabetic ketoacidosis, which is therefore more characteristic of type 1 diabetes, whereas partial insulin deficiency will suppress hepatic ketogenesis but not hepatic glucose output, resulting in hyperglycaemia and dehydration, and culminating in the hyperglycaemic hyperosmolar state. Hyperglycaemia is characteristic of diabetic ketoacidosis, particularly in the previously undiagnosed, but it is the acidosis and the associated electrolyte disorders that make this a life-threatening condition. Hyperglycaemia is the dominant feature of the hyperglycaemic hyperosmolar state, causing severe polyuria and fluid loss and leading to cellular dehydration. Progression from uncontrolled diabetes to a metabolic emergency may result from unrecognised diabetes, sometimes aggravated by glucose containing drinks, or metabolic stress due to infection or intercurrent illness and associated with increased levels of counter-regulatory hormones. Since diabetic ketoacidosis and the hyperglycaemic hyperosmolar state have a similar underlying pathophysiology the principles of treatment are similar (but not identical), and the conditions may be considered two extremes of a spectrum of disease, with individual patients often showing aspects of both. Pathogenesis of DKA and HHS Insulin is a powerful anabolic hormone which helps nutrients to enter the cells, where these nutrients can be used either as fuel or as building blocks for cell growth and expansion. The complementary action of insulin is to antagonise the breakdown of fuel stores. Thus, the relea Continue reading >>
What are the two most common complications of diabetes mellitus?
The two most common life-threatening complications of diabetes mellitus include diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS).
What are the worst complications of diabetes?
Two of the worst complications of diabetes are DKA and HHNK. There are striking disparities between these two diseases when it comes to pathophysiology and other aspects. DKA is called diabetic ketoacidosis and is one of the deadliest complications that one can experience in diabetes.
How many units of insulin did Howard Root give in the first 3 h of treatment?
In 1945, Howard Root in Boston described how they had improved the outcomes for people with diabetic ketoacidosis (DKA), reducing mortality to 12% by 1940 and to 1.6% by 1945 using high doses of insulin—giving an average of 83 units within the first 3 h of treatment in 1940 and 216 units by 1945 [3].
How to diagnose HHNS?
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. Serum osmolality, a test that measures the body's water/electrolyte balance , also is used to diagnose HHNS.
What is HHNS in diabetes?
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is a potentially deadly condition that can develop as a result of infection or illness in people with uncontrolled type 2 diabetes or when diabetes medications aren't taken as directed. Some also refer to this as a "diabetic coma.".
What is a HHNS?
HHNS is a relatively rare complication of diabetes, accounting for just 1% of hospital admissions among people with diabetes. 1 . HHNS is sometimes referred to by other names: Hyperglycemic hyperosmolar nonketotic coma (HHNK) Nonketotic hyperosmolar syndrome (NKHS) Diabetic hyperosmolar syndrome. Diabetic HHS.
Why does HHNS happen?
This dehydration occurs because elevated levels of glucose cause blood to become thicker and result in the body needing to produce more urine in order to lower them. 3 .
How to tell if you have HHNS?
The symptoms of HHNS may appear slowly, taking days or even weeks to fully develop. Common symptoms include: 2 1 Blood glucose levels over 600 milligrams per deciliter (mg/dl) 2 Frequent urination 3 Extreme thirst 4 Dry mouth 5 Confusion or sleepiness 6 Skin that is warm and dry without sweating 7 Fever (usually over 101 F) 8 Weakness or paralysis on one side of the body 9 Loss of vision 10 Hallucinations
How to prevent HHNS?
The best way to prevent HHNS is by keeping your blood sugar levels under control. Test them regularly using a glucometer, work with your doctor to make sure you're taking any diabetes medications as prescribed, and learn the warning signs of elevated glucose levels and dehydration, such as extreme thirst and frequent urination, so you know to seek treatment when you need it. Educate your loved ones and coworkers to also recognize the early signs of blood sugar imbalance, so they can send for help, too.
What are the symptoms of hyperglycemia?
Weakness or paralysis on one side of the body. Loss of vision. Hallucinations. If you have symptoms of extreme thirst, frequent urination, confusion, and blurry vision, it's important that you seek medical care immediately, as you could be experiencing symptoms of hyperglycemia, which may be life-threatening.
What is HHNS in medical terms?
Hyperglycaemic hyperosmolar non-ketotic syndrome ( HHNS) is a life-threatening complication of uncontrolled diabetes mellitus. This syndrome is characterised by severe hyperglycaemia, a marked increase in serum osmolality, and clinical evidence of dehydration without significant accumulation of ketoa ….
What drugs are associated with osmotic diuresis?
Patients receiving certain drugs including diuretics, corticosteroids, beta-blockers, phenytoin, and diazoxide are at increased risk of developing this syndrome. Patients usually present with a prolonged phase of osmotic diuresis leading to severe depletion of both the intracellular and extracellular fluid volumes.
Is HHNS a complication of diabetes?
HHNS is typically observed in elderly patients with non-insulin-dependent diabetes mellitus, although it may rarely be a complication in younger patients with insulin-dependent diabetes, or those without diabetes following severe burns, parenteral hyperalimentation, peritoneal dialysis, or haemodialysis.
What is the difference between DKA and HHNK?
Diabetic Ketoacidosis (DKA) is observed with the presence of ketoacidosis and fruity odor from the mouth whereas Hyperosmolar Hyperglycemic Non-Ketoacidosis (HHNK) is observed with the absence of ketoacidosis and with no odor change.
What is a DKA?
DKA is fully known as Diabetic Ketoacidosis which is a medical emergency in diabetes that is observed in the patient ’s body in a short period which works at a high pace. Diabetic Ketoacidosis (DKA) is a common illness found in diabetic patients.
What is the name of the condition where you can't drink water?
Symptoms of Hyperosmolar Hyperglycemic Non-Ketoacidosis (HHNK) are a sudden urge of drinking water even when you are not thirsty, urination several times a day, concentrated specific dark-colored urine, and dehydration. Medications. Medications for Diabetics Ketoacidosis (DKA) is medicine and precautions.
What is a DKA diabetic?
Diabetics Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic Non-Ketoacidosis (HHNK) is the type of medical emergencies that are observed in the diabetic patient. Both of them are a life-threatening disease which keeps patient lives in danger.
Is ketoacidosis dangerous for diabetics?
Diabetics Ketoacidosis (DKA) is less dangerous. Hyperosmolar Hyperglycemic Non-Ketoacidosis (HHNK) is very dangerous. Period. Diabetics Ketoacidosis (DKA) works at a fast pace and hence symptoms are observed in a short period. Hyperosmolar Hyperglycemic Non-Ketoacidosis (HHNK) works at a slow pace and hence symptoms are observed for a long period.
Is diabetes a king of diseases?
But that thinking is fully wrong, Diabetes is known as the king of diseases, it is believed that diabetes brings many more disease together with him.
Can diabetes be cured?
And without proper medications, monthly checkups, and utmost care of sugar intakes, diabetes cannot be cured. Even if you don’t have diabetes that doesn’t mean you won’t get diabetes in a long run. Precaution is always better than cure. Utmost good care should be taken of the body too and not just face, body, and hair.