Please practice handwashing and social distancing, and check out our resources for adapting to these times. Management of diabetic ketoacidosis and hyperosmolar. Pdf diagnosis and management of hyperglycemic emergencies. The mortality rate from hhs is significantly higher than for dka reported as high as 20% in adults vs. Diabetic ketoacidosis and hyperosmolar hyperglycemic state. Additionally, edocr and hhsocr, along with the department of justice doj, share authority to enforce title ii of the ada, 42 u.
When applicable, information has been organized into groups of five to facilitate retention and recall. Diabetic ketoacidosis and hyperosmolar hyperglycemic. May 17, 2018 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. Mastering emergency medicine secure the abcs consider or give ngt. Dka vs hhs dka means diabetic ketoacidosis and hhs means hyperosmolar hyperglycemic syndrome. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. This presentation was present by my friend during emergency posting seminar with dr. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. Patients with sc insulin pump safer to disconnect pump, start iv insulin for mild dka, interrogate pumpflow issue, may discuss with endocrinologist 7. This document is coded jbds 06 in the series of jbds documents. Navigating the underground world of dka christina canfield, msn, rn, acnsbc, ccrn clinical nurse specialist cleveland clinic respiratory institute objectives upon completion of this activity the learner will be able to describe the physiology of dka upon completion of this activity the learner.
Assisted living establishment, shared housing establishment, sheltered care facility. The diabetes specialist team should be involved as soon as possible after admission. Objectives describe etiologies of and differences among the 3 major diabetic emergencies. This is not intended to replace the independent medical or professional judgment. Non gap acidosis during treatment of dka is common, and does not necessarily require continued iv insulin infusion it is not clear if excess sodium chloride administration is the sole cause for non gap acidosis during treatment of dka. The authors appreciate the guidance of kirsten beronio and kristina west aspe and david devoursney hhs substance abuse and mental health services administration samhsa. Newer blood gas analyzers have the ability to report electrolyte values and glucose in addition to ph, so this diagnostic process could be condensed in diagnosing diabetic. The goal of this course is to describe diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs. Hyperosmolar hyperglycemic state hhs honk, nkhc, hhnk dka insulin levels very low ketoacidosis profound glucose 600 hco3 5 15 osm 300 325 age young onset acute associated diseases rare seizures very rare coma rare mortality approaches 0 hhs. Dka, and is treated with iv insulin after adequate fluid resuscitation. When comparing the two, hhs has a higher mortality. Dka and hyperosmolar syndrome pearls and pitfalls corey m.
Aug 4, 2014 chart showing differences between dka and hhshhns. Diabetic ketoacidosis dka vs hyperosmolar hyperglycemic syndrome hhs. Dka hhs management no continue work up for alternative diagnosis hyperglycemic emergency management dka hhs1 adult does patient have a diagnosis of hyperglycemic emergency. Ask me anything information for nursing students and new nurses from the former dean of a nursing program in texas with years of nursing experience search results for. Department of health and human services hmis homeless management information systems hud u. Dkahhs management no continue work up for alternative diagnosis hyperglycemic emergency management dkahhs1 adult does patient have a diagnosis of hyperglycemic emergency. Guidelines for the management of patients with dka and hhs in.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. Page 1 of 7 hyperglycemic emergency management dkahhs1 adult. Hhs dka hhs glucose 250600 600 sodium 1255 5145 potassium normalinc normal bicarbonate 7. Hhs pts may be very sensitive to exogenous insulin 6. Phase type of fluid rate iv regular insulin endpointgoal 0. Hhs is associated with a significant morbidity and higher mortality than dka and must be diagnosed promptly and managed intensively savage 2011. Navigating the underground world of dka christina canfield, msn, rn, acnsbc, ccrn clinical nurse specialist cleveland clinic respiratory institute objectives upon completion of this activity the learner will be able to describe the physiology. Pdf the value of venous blood gas analysis in the diagnosis. Hyperosmolar hyperglycemic state how to manage your. Precipitating causes are usually infection or insulin. Like dka, hhs is characterized by very high blood glucose levels, but unlike in dka, people with hhs do not generally have ketones in their blood or urine.
The mortality rate from hhs is significantly higher than for dka reported as. Civil rights edocr and hhs office for civil rights hhsocr enforce section 504, which prohibits discrimination based on disability by recipients of federal financial assistance, including in early childhood programs receiving federal financial assistance from ed or hhs. In 2010, among adults aged 20 years or older, hyperglycemic crisis caused 2,361 deaths in the u. The diagnosis of dka was made according to american diabetes association criteria. The etiology of dka vs hhs the fundamental underlying issue in both dka and hhs is an absolute or relative lack. Diabetic ketoacidosis dka, hyperosmolar hyperglycemic state hhs and hypoglycemia formulate a basic treatment plan for each of the above understand the basics of pump management counsel patients and healthcare trainees about diagnosis and management of the above metabolic emergencies.
Greater reductions in potassium dose may be necessary if patient is anuric b. Target audience this educational activity has been designed to meet the educational needs of pharmacists and registered nurses involved in the management of patients with diabetes. Purpose provide clinicians treating patients with diabetes the. Hhs hhs and dka are of two of the most serious complications form diabetes hospital admissions for hhs are lower than the rate for dka and accounts for less than 1 percent of all primary diabetic admissions mortality rate for patients with hhs is between 10 and 20 percent, which is approximately 10 times higher than that for dka. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Then to learn to recognize the difference between dka and hhs, the pathogenesis, treatments and complication of dka and hhs. Mortality rate for hhs coma higher than for ketoacidosis 40 to 70%. Busted knowledge into our heads, then was gone like a frat boy bearing rufees, it seems the whole thing is getting seriously drawn out. Nov 02, 2009 this presentation was present by my friend during emergency posting seminar with dr. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome.
Diabetic ketoacidosis and hyperglycemic hyperosmolar. Title diabetic ketoacidosis versus hyperosmolar hyperglycemia state authored by lynn summers bsn, cen, lnc course no dkhh100208 contact hour 1 purpose the goal of this course is to describe diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs. Hyperosmolar hyperglycemic state hhs hhs and dka are of two of the most serious complications form diabetes hospital admissions for hhs are lower than the rate for dka and accounts for less than 1 percent of all primary diabetic admissions mortality rate for patients with hhs is between 10 and 20 percent, which is approximately 10 times higher than that for dka. Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a conse. Department of health and human services awards program policy update, dated january, 2010. This issue is a violation of section 508 and wcag 2.
Vanderbilt university medical center metro nashville fire department nashville international airport nashville, tn dka a 21 year old grad student presents in dka. Dka and hhs rarely results from the metabolic complications of hyper glycemia or metabolic acidosis but rather relates to the. 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. Department of housing and urban development icm intensive case management lbhp louisiana behavioral health partnership. Dka is characterized by hyperglycemia, ketone body formation and metabolic acidosis. These disorders can occur in both type 1 and type 2 dm. Hospital admissions for hhs are lower than the rate for dka and accounts for. Human resources manual hhs instructions 4511 material. 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. Hhs is associated with a significant morbidity and higher mortality than dka and must. Hyperosmolar hyperglycaemic state hhs is a diabetic emergency that although typically occurring in the elderly, is presenting in younger adults and teenagers, often as the initial presentation of type 2 diabetes mellitus t2dm.
Hyperosmolar hyperglycemic state american family physician. Mnemonics maybe these will come in handy in nursing school helpful nursing. Westerberg, do, cooper medical school of rowan university, camden, new jersey d iabetic ketoacidosis dka. Mar 22, 2006 diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are the two most serious metabolic complications of diabetes mellitus dm. Chart showing differences between dka and hhshhns diabetic. 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. Patients with underlying diabetes type 1 or type 2 are at risk of developing dka andor hhs in times of critical illness. Mild hyperglycemia, even with ketones and mild acidosis, can often be managed without iv fluids or. Acep 2018 dka and hyperosmolar syndrome pearls and. Sri mokshagundam is an associate professor on faculty with the university of louisville in the department of endocrinology, metabolism, and diabetes. Adult dka management these recommendations do not take into account individual patient situations, and do not substitute for clinical judgment. Guidelines for the management of patients with dka and hhs.
Pdf treatment of diabetic ketoacidosis dkahyperglycemic. Oct 06, 2017 instead, he had a condition called hyperosmolar hyperglycemic state, or hhs. Dec 01, 2017 hyperosmolar hyperglycemic state hhs is a lifethreatening endocrine emergency that most commonly affects adults with type 2 diabetes mellitus. Both documents agree that the primary treatment should.
Both forms of hyperglycemic crisis result in osmotic diuresis and urinary wasting of electrolytes. Largescale studies to determine optimal management of dka and hhs are lacking. The management of the hyperosmolar hyperglycaemic state. Though there are many differences between dka and hhs, the basic problem is associated with insulin deficiency. According to the american diabetes association ada, while dka has a death rate. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are diabetic emergencies that cause high morbidity and mortality.
Fluid losses in hhs are estimated to be between 100 220 mlkg 1022 litres in a person weighing 100 kg kitabachi 2009. Instead, he had a condition called hyperosmolar hyperglycemic state, or hhs. Primarily affects elderlyonset slow treatment same as with dka insulin pumps and cgm they are high tech sophisticated insulin delivery systemsdoes not think for user does not automatically do everything for usernot yet can make care easiermore flexible. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious and lifethreatening hyperglycemic. Mneumonics mnemonics maybe these will come in handy in nursing school helpful nursing mnemonics fluid imbalance, ss of bleeding, etc.
Add dextrose to fluids when glucose pdf hhs making files accessible va pdf tagging tutorial webaim pdf accessibility. Adobe tagged pdf hhs making files accessible va pdf tagging tutorial webaim pdf accessibility. Dka guideline for diagnosis hhs guideline for diagnosis. Diabetic ketoacidosis and hyperglycaemic hyperosmolar state gmed. Jim verdier mathematica provided valuable feedback on this report and guidance throughout the project. Title diabetic ketoacidosis versus hyperosmolar hyperglycemia. Il1 compendium of residential care and assisted living regulations and policy. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are the two most serious metabolic complications of diabetes mellitus dm. Both dka and hhs are the two complications of diabetes mellitus. Treatment of dka and hhs also differs with respect to timing of fluid and insulin initiation. Serum chemistry electrolyte values were considered to be the criterion standard.
574 580 293 1029 566 1087 449 1521 73 1263 843 845 599 489 672 972 568 1029 618 1384 164 1420 1524 25 1512 105 1214 213 123 767 84 441 1461 351 176 429