What is the treatment for HHNS?
Treatment. Treatment typically involves starting intravenous (IV) fluids (saline solution delivered through a needle into a vein) to rehydrate the body quickly. It also may require IV insulin to bring down blood sugar levels. If you are hospitalized due to HHNS, you may be kept overnight for observation.
What is Nonketotic hyperglycemia?
Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS), also known as Hyperosmolar Hyperglycaemic State (HHS) is a dangerous condition resulting from very high blood glucose levels. HHNS can affect both types of diabetics, yet it usually occurs amongst people with type 2 diabetes.
Which IV fluid is best for hyperglycemia?
Normal saline (0.9% sodium chloride) is the most commonly used intravenous fluid in treating DKA, but it has a very high concentration of chloride and can lead to additional acid production when given in large volumes.
What are the signs and symptoms of HHNK?
Symptoms of HHNS can include:
- very high blood sugar levels.
- dry mouth.
- fast heart rate.
- thirst.
- frequent urination.
- nausea, vomiting, or stomachache.
- confusion, slurred speech, or weakness on one side of your body.
Why is dextrose given in HHS?
When the plasma glucose level reaches 300 mg/dl, insulin infusion may be reduced to 0.05-0.1 unit/kg/hour and dextrose can be added to the fluids to keep the glucose level between 250-300 mg/dl until hyperosmolality has resolved and the patient is alert.
What type of insulin is used for HHS?
Class Summary. Although many patients with hyperosmolar hyperglycemic state (HHS) respond to fluids alone, intravenous (IV) insulin in dosages similar to those used in diabetic ketoacidosis (DKA) can facilitate correction of hyperglycemia.
Can you have diabetes without ketones in urine?
You can have high blood sugar without having ketones in your blood and/or urine. Untreated high blood sugar can lead to DKA. This is why it’s important to treat high blood sugar with insulin as soon as possible. Although it’s not as common, you can be in DKA even if your blood sugar is lower than 250 mg/dL.
Why is normal saline used in hyperglycemia?
The initial goal of rehydration therapy is repletion of extracellular fluid volume by intravenous administration of isotonic saline to restore intravascular volume; this will decrease counterregulatory hormones and lower blood glucose, which should augment insulin sensitivity.
Which electrolyte is most affected by hyperglycemia?
This slow onset promotes the slow and profound dehydration patients can experience. During this time both hyperglycemia and hyperosmolarity drive a fluid shift that leads to intracellular dehydration and loss of electrolytes. The two most significant electrolytes depleted are sodium and potassium.
Which is worse DKA or HHS?
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%.
Does HHS need insulin drip?
Insulin is generally not recommended in the initial management of HHS. Rather, recommendations are to continue aggressive fluid management and start an insulin drip once the drop in blood glucose levels falls below 50 mg/dL/hr. However, in cases of mixed DKA and HHS, insulin may be needed to stop ketosis.
Why is Ringer lactate not given in diabetes?
The infusion of Ringer’s lactate may also cause elevations in serum lactate levels [25, 26], which may be exaggerated in liver failure and could in turn affect clinical decision-making. The lactate in Ringer’s may be converted to glucose and could exacerbate hyperglycemia in the DKA and HHS setting [27].
At what sugar level is diabetic coma?
A diabetic coma could happen when your blood sugar gets too high — 600 milligrams per deciliter (mg/dL) or more — causing you to become very dehydrated. It usually affects people with type 2 diabetes that isn’t well-controlled. It’s common among those who are elderly, chronically ill, and disabled.
At what blood sugar level does ketosis start?
We can measure one ketone body in the bloodstream, beta hydroxybutyrate (BHB), and when BHB is within a 0.5 mmol/L – 1.0 mmol/L range would be considered a “light nutritional ketosis.” BHB levels within 1.0 mmol/L- 3.0 mmol/L would be considered a more optimal ketosis.
Which IV fluid is best for hypoglycemia?
IV dextrose is the best treatment for inpatients and for patients found by emergency medical services personnel. IV dextrose is available in different concentrations. Concentrated IV dextrose 50% (D50W) is most appropriate for severe hypoglycemia, providing 25 g of dextrose in a standard 50-mL bag.
Can you give 5 dextrose to diabetics?
Avoid dextrose
If you are diabetic and your doctor prescribes dextrose oral gel or tablets, these should only be used when you have a low blood sugar reaction.
Does normal saline help with hyperglycemia?
How does hyperglycemia affect potassium?
High blood sugar damages the kidneys, which normally remove extra potassium from your body. People with diabetes and high potassium are more likely to have heart problems and other complications. Your doctor might suggest tips like these to lower your potassium if it’s too high: Eat a low-potassium diet.
What are the 3 diagnostic criteria for DKA?
DIFFERENTIAL DIAGNOSIS
Three key features of diabetic acidosis are hyperglycemia, ketosis, and acidosis. The conditions that cause these metabolic abnormalities overlap.
Why is potassium low in HHS?
The level of potassium might be high or low. A low level of insulin can cause an extracellular shift of potassium. However, because of ongoing urinary losses, the total body potassium is low in both HHS and DKA.
Which drip is recommended for diabetic patient?
For decades, 0.9% saline has been the fluid of choice for diabetic ketoacidosis, and its use continues to be advocated in modern textbooks on diabetes.
When is hyperglycemia an emergency?
According to the American Academy of Family Physicians (AAFP), hyperglycemic hyperosmolar syndrome (HHS) occurs when blood sugar levels become dangerously high, usually above 600 mg/dl. This may happen with or without DKA, and it can be life-threatening.
How do you bring blood sugar down quickly?
When your blood sugar level gets too high — known as hyperglycemia or high blood glucose — the quickest way to reduce it is to take fast-acting insulin. Exercising is another fast, effective way to lower blood sugar.
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Eat a consistent diet
- whole grains.
- fruits.
- vegetables.
- lean proteins.
What ketone level is too high?
1.6 to 2.9mmol/L means you’re at an increased risk of DKA and should contact your diabetes team or GP as soon as possible. 3mmol/L or above means you have a very high risk of DKA and should get medical help immediately.
What is the difference between ketosis and ketoacidosis?
Inducing ketosis is the aim of a ketogenic diet, or “keto” diet, which is a high-fat, very-low-carb diet that can help people lose weight. Ketoacidosis occurs when the body produces dangerously high levels of ketones, and it is often a complication of type 1 diabetes.