HYPEROSMOLAR HYPERGLYCEMIC STATE ADA PDF

Epidemiology of Hyperosmolar Hyperglycemic State The incidence of hyperosmolar hyperglycemic state is unknown. The condition is more common in the elderly and in patients with type 2 diabetes. Diabetic ketoacidosis is more common in the young and in patients with type 1 diabetes. Hyperosmolar hyperglycemic state was previously known as diabetic coma. Pathophysiology of Hyperosmolar Hyperglycemic State Insulin deficiency and inadequate fluid intake, coupled with resulting hyperglycemia, are the main trigger agents for HHS. A lack of glucose entry to cells for use leads to an increase in the levels of the counter-regulatory hormones that is associated with increased gluconeogenesis, accelerated conversion of glycogen to glucose, and inadequate use of glucose by peripheral tissues due to insulin resistance.

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Epidemiology of Hyperosmolar Hyperglycemic State The incidence of hyperosmolar hyperglycemic state is unknown. The condition is more common in the elderly and in patients with type 2 diabetes. Diabetic ketoacidosis is more common in the young and in patients with type 1 diabetes. Hyperosmolar hyperglycemic state was previously known as diabetic coma. Pathophysiology of Hyperosmolar Hyperglycemic State Insulin deficiency and inadequate fluid intake, coupled with resulting hyperglycemia, are the main trigger agents for HHS.

A lack of glucose entry to cells for use leads to an increase in the levels of the counter-regulatory hormones that is associated with increased gluconeogenesis, accelerated conversion of glycogen to glucose, and inadequate use of glucose by peripheral tissues due to insulin resistance.

The deficiency of insulin is not severe enough to trigger ketoacidosis as seen with DKA. This can lead to severe dehydration and the patient would eventually enter a hyperosmolar state; therefore, patients in hyperosmolar hyperglycemic state usually have a much higher serum glucose level compared to those with diabetic ketoacidosis.

Elevated serum glucose levels create an osmolar gradient that withdraws water from the cells. Infection is the most common cause of hyperosmolar hyperglycemic state. Patients with stroke, acute myocardial infarction, or trauma usually have an acute and dramatic increase in the levels of glucagon and cortisol in addition to an elevation in norepinephrine and epinephrine levels; therefore, these conditions are also common causes of hyperosmolar hyperglycemic state in type 2 diabetics.

Children with type 1 or type 2 diabetes who develop an acute circulatory, nervous, or genitourinary disease might develop hyperosmolar hyperglycemic state. Insulin deficiency. Renal failure. Use of diuretics. Increased levels of glucagon and counteregulatory hormones, such as catecholamines, cortisol and growth hormone, lead to uncontrolled hyperglycemia. The anion gap is variable. Clinical Presentation of Hyperosmolar Hyperglycemic State Patients who develop hyperosmolar hyperglycemic state syndrome usually become stupor and comatose.

Because of the severe dehydration, you expect to see tachycardia, hypotension, decreased skin turgor, and sunken eyes; however, if the cause of the hyperosmolar hyperglycemic state is myocardial infarction, you might see other cardiac rhythms different from sinus tachycardia. Patients might have:.

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Hyperosmolar Hyperglycemic State (HHS)

It may result from osmotically driven movement of water into the central nervous system when plasma hyperpsmolar declines too rapidly during treatment of DKA or HHS. The American journal of emergency medicine ; 5: Once hypotension improves, the corrected serum sodium level is calculated. Maletkovic J, Drexler A. Management of adult diabetic ketoacidosis. Management of hyperglycemic crises in patients with diabetes.

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Hyperosmolar Hyperglycemic State (HHS) — Symptoms and Treatment

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Complications

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