Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are the two most serious metabolic complications of diabetes mellitus dm. Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a conse. Apis in health care are already doing the same things. Dka guideline for diagnosis hhs guideline for diagnosis.
Hyperosmolar hyperglycemic state previously referred to as hyperglycemic hyperosmolar nonketotic coma hhnk and nonketotic hyperosmolar syndrome nkhs is a complication of type 2 diabetes mellitus and has an estimated mortality rate of up to 20%, which is significantly higher than the mortality for diabetic ketoacidosis currently 600 mgdl, arterial ph 7. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Landsberg md, in clinical practice manual for pulmonary and critical care medicine, 2018. Combining lr with an equal volume of d10w effectively creates a solution of. Prebreakfast administer both glargine and aspart dose according to premeal aspart order set. Dka and hhs underlined clinical signs hyperglycemia blood glucose no glucose absorption into muscle, fat cells polyphagia hunger metabolic acidosis anion gap. Human resources manual hhs instructions 4511 material. In addition to section 508 requirements, hhs has policies, standards, and requirements for electronic documents that include but are not limited to the following. Careful monitoring by experienced physicians is needed during treatment for diabetic ketoacidosis and hhs.
Dka and hhs are lifethreatening emergencies and are the most serious complications of diabetes. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious and lifethreatening hyperglycemic emergencies in patients with diabetes. This presentation was present by my friend during emergency posting seminar with dr. Hyperosmolar hyperglycemic state hhs dka is characterized by uncontrolled hyperglycemia mild to severe, metabolic acidosis, and increased total body ketone concentrations with the degree of neurologic abnormalities depending. Both dka and hhs are the two complications of diabetes mellitus. This chapter covers diabetes and its related complications. The checklist from section a forward is based on the wcag 2. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Dka is characterized by hyperglycemia, ketone body formation and metabolic acidosis. Although the pathogenesis of dka is better understood than that of hhs, the basic underlying mechanism for both disorders is a reduction in the net effective concentration of. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic syndrome hhs are two acute complications of diabetes that can result in increased morbidity and mortality if not efficiently and effectively treated. These disorders can occur in both type 1 and type 2 dm.
Hhs is most commonly seen in older individuals 65 years of age with type 2 diabetes. The patient can now access health information from the app and can merge this information with other health information from other sources for example, patient portals to access all the data in one place. Patients with sc insulin pump safer to disconnect pump, start iv insulin for mild dka, interrogate pumpflow issue, may discuss with endocrinologist 7. Endocrine emergencies in dogs and cats veterinary clinics. The checklist below, a series of tables, is based on the content of the pdf. Common mostly type i dm younger 18meql poor compliance general malaise high blood. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are similar but distinct diabetic emergencies that are. Management of diabetic ketoacidosis and hyperosmolar. Dka is characterized by ketoacidosis and hyperglycemia, while hhs usually has more severe hyperglycemia but no ketoacidosis table 1. Its much rarer for people with type 2 diabetes to develop dka, since they usually have some remaining insulin production. In general, it is estimated that the rate of hospital admissions due to hhs is lower than the rate due to dka and accounts for merge cbp and ice page 2 chairman asked the dhs office of inspector general oig to assess the merits of merging cbp and ice as well as the role of bts. The criteria for hyperglycemic hyperosmolar state hhs include. 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. Guidelines for the management of patients with dka and hhs in the ed.
Hhs dka hhs glucose 250600 600 sodium 1255 5145 potassium normalinc normal bicarbonate 7. Dka hhs ispad consensus guidelines pediatric diabetes. Ascension health icu dka hhs patient care blood glucose monitoring poc t. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are two. By combining the significant risk factors for dka and hhs readmission identified in this study. Predictors of recurrent hospital admission for patients presenting. Dka is a syndrome in which insulin deficiency and glucagon excess combine to produce a hyperglycemic. Reevaluate appropriateness of replacement fluid type frequently. Dka vs hhs dka means diabetic ketoacidosis and hhs means hyperosmolar hyperglycemic syndrome. Hhs lacks the marked lipolysis, ketonemia, and acidosis associated with dka. Somewhere between 5 and 8 of every 1,000 people with type 1 diabetes develops dka each year, resulting in about 5,000 hospital admissions per year.
Crackcast e126 diabetes mellitus and disorders of glucose. Dka and hhs protocol changes diabetic ketoacidosis dka vs. Serum osmolality has been shown to correlate significantly with mental status in dka and hhs 5,6,20,21,22,23 and is the most important determinant of. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Complications may include seizures, disseminated intravascular coagulopathy. Diabetic ketoacidosis dka and hyper osmolar hyperglycemic. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Study dka vs hhs flashcards at proprofs will help distinguish btw dka and hhs. Dka sample physician order sheet dka glucose, fluid and insulin management dka nursing protocol including the twobag method dka recipes for making solutions. In patients with diabetic ketoacidosis, this is always followed by administration of insulin, usually via an intravenous insulin infusion that is continued until resolution of ketonemia, but potentially via the subcutaneous route in mild cases.
Greater reductions in potassium dose may be necessary if patient is anuric b. Even if you converted from office using the acrobat add in, its a good idea to compare that tagging with this retagging. Guidelines for the management of patients with dka and hhs. Diabetic emergencies, diagnosis and clinical management. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs. Overlap between the characteristic features of hhs and dka may occur, and some. Hhs pts may be very sensitive to exogenous insulin 6. It is a consequence of a relative or an absolute insulin deficiency in combination with an excess of counterregulatory hormones primarily glucagon and catecholamines, but also cortisol and growth hormone. Section 508 guide tagging pdfs in adobe acrobat pro. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. Dka is caused by relative or absolute insulin deficiency, which results in hyperglycemia, ketonemia, dehydration, electrolyte imbalances, and acidosis. Monitor bun, creatinine, and hematocrit every 6 to 8 hours until normal. Pdf hyperglycemic crises in adult patients with diabetes.
Generally speaking, dka affects people with type 1 diabetes. Although dka and hhs are often discussed as separate entities, they represent points along a spectrum of hyperglycemic emergencies due to poorly controlled diabetes. The state licenses two settings that provide housing, meals, and supportive services to adults who cannot live independently but do not require the type of care provided in a nursing home. Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dl, a ph less than 7. Pdf diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the two most serious acute metabolic complications of. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Diabetic ketoacidosis and hyperosmolar hyperglycemic state.
The hyperglycemic hyperosmolar state hhs or hyperglycemic. Analysis of variables associated with recurrent dka and hhs admission has the potential to improve. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. The vast majority of dka patients can be diagnosed and managed perfectly. Hyperosmolar hyperglycemic state an overview sciencedirect. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped. For patients with suspected dka or hhs, consider obtaining serum electrolytes, glucose, calcium, magnesium, phosphorus, and blood gases at least every 2 to 4 hours in more severe cases. When comparing the two, hhs has a higher mortality. State to create hhs department kathleen gray, detroit free press lansing bureau published 7. Though there are many differences between dka and hhs, the basic problem is associated with insulin deficiency. Dka and hhs are 2 diabetic crises that require emergency intervention. Progression to dka or hhs requires both a lack of insulin as well as increasing con. Precipitating causes are usually infection or insulin.
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