Diabetic ketoacidosis and hyperglycemic hyperosmolar. The authors appreciate the guidance of kirsten beronio and kristina west aspe and david devoursney hhs substance abuse and mental health services administration samhsa. These disorders can occur in both type 1 and type 2 dm. 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. Title diabetic ketoacidosis versus hyperosmolar hyperglycemia. Adult dka management these recommendations do not take into account individual patient situations, and do not substitute for clinical judgment.
Precipitating causes are usually infection or insulin. 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. It is a lifethreatening emergency that, although less common than its counterpart, diabetic ketoacidosis dka, has a much higher mortality rate, reaching up to 510%. Dka hhs management no continue work up for alternative diagnosis hyperglycemic emergency management dka hhs1 adult does patient have a diagnosis of hyperglycemic emergency. Then to learn to recognize the difference between dka and hhs, the pathogenesis, treatments and complication of dka and hhs. Chart showing differences between dka and hhshhns diabetic. Jim verdier mathematica provided valuable feedback on this report and guidance throughout the project. Hhs pts may be very sensitive to exogenous insulin 6. 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.
Both documents agree that the primary treatment should. This issue is a violation of section 508 and wcag 2. Serum chemistry electrolyte values were considered to be the criterion standard. Pdf diagnosis and management of hyperglycemic emergencies. According to the american diabetes association ada, while dka has a death rate. Dka is characterized by hyperglycemia, ketone body formation and metabolic acidosis. 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. Please practice handwashing and social distancing, and check out our resources for adapting to these times. 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. Treatment of dka and hhs also differs with respect to timing of fluid and insulin initiation. Mortality rate for hhs coma higher than for ketoacidosis 40 to 70%.
Hyperosmolar hyperglycemic state american family physician. 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. Hhs is associated with a significant morbidity and higher mortality than dka and must be diagnosed promptly and managed intensively savage 2011. Hhs dka hhs glucose 250600 600 sodium 1255 5145 potassium normalinc normal bicarbonate 7. 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 diabetes specialist team should be involved as soon as possible after admission. In 2010, among adults aged 20 years or older, hyperglycemic crisis caused 2,361 deaths in the u. 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. Dka vs hhs dka means diabetic ketoacidosis and hhs means hyperosmolar hyperglycemic syndrome. Patients with underlying diabetes type 1 or type 2 are at risk of developing dka andor hhs in times of critical illness. When comparing the two, hhs has a higher mortality. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a conse. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Both forms of hyperglycemic crisis result in osmotic diuresis and urinary wasting of electrolytes. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm.
Page 1 of 7 hyperglycemic emergency management dkahhs1 adult. Objectives describe etiologies of and differences among the 3 major diabetic emergencies. The diagnosis of dka was made according to american diabetes association criteria. This presentation was present by my friend during emergency posting seminar with dr. 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. The etiology of dka vs hhs the fundamental underlying issue in both dka and hhs is an absolute or relative lack. This is not intended to replace the independent medical or professional judgment. The mortality rate from hhs is significantly higher than for dka reported as. 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. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the most serious and lifethreatening hyperglycemic. 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.
Dka and hhs rarely results from the metabolic complications of hyper glycemia or metabolic acidosis but rather relates to the. 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. Assisted living establishment, shared housing establishment, sheltered care facility. 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. Department of housing and urban development icm intensive case management lbhp louisiana behavioral health partnership. Department of health and human services awards program policy update, dated january, 2010. Hospital admissions for hhs are lower than the rate for dka and accounts for. Greater reductions in potassium dose may be necessary if patient is anuric b. Management of diabetic ketoacidosis and hyperosmolar. Diabetic ketoacidosis and hyperglycaemic hyperosmolar state gmed. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are diabetic emergencies that cause high morbidity and mortality. Aug 4, 2014 chart showing differences between dka and hhshhns. Hhs is associated with a significant morbidity and higher mortality than dka and must.
Mnemonics maybe these will come in handy in nursing school helpful nursing. Purpose provide clinicians treating patients with diabetes the. Mastering emergency medicine secure the abcs consider or give ngt. 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. This document is coded jbds 06 in the series of jbds documents.
Dka guideline for diagnosis hhs guideline for diagnosis. Westerberg, do, cooper medical school of rowan university, camden, new jersey d iabetic ketoacidosis dka. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Diabetic ketoacidosis and hyperosmolar hyperglycemic state. Mar 22, 2006 diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are the two most serious metabolic complications of diabetes mellitus dm. 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. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Largescale studies to determine optimal management of dka and hhs are lacking. The tab order is not specified for at least one page of the document. The goal of this course is to describe diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs. Dka, and is treated with iv insulin after adequate fluid resuscitation. Add dextrose to fluids when glucose pdf hhs making files accessible va pdf tagging tutorial webaim pdf accessibility.
Diabetic ketoacidosis dka vs hyperosmolar hyperglycemic syndrome hhs. 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. 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. Dka and hyperosmolar syndrome pearls and pitfalls corey m. Vanderbilt university medical center metro nashville fire department nashville international airport nashville, tn dka a 21 year old grad student presents in dka.
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. Though there are many differences between dka and hhs, the basic problem is associated with insulin deficiency. Phase type of fluid rate iv regular insulin endpointgoal 0.
Dka is the most common cause of death in children and adolescents with type 1 diabetes. The management of the hyperosmolar hyperglycaemic state. Pdf treatment of diabetic ketoacidosis dkahyperglycemic. Guidelines for the management of patients with dka and hhs in.
Mel the beauty of emrap to me was that it didnt go on and on, it got to the point boom. 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. Fluid losses in hhs are estimated to be between 100 220 mlkg 1022 litres in a person weighing 100 kg kitabachi 2009. The mortality rate from hhs is significantly higher than for dka reported as high as 20% in adults vs. Il1 compendium of residential care and assisted living regulations and policy.
Mild hyperglycemia, even with ketones and mild acidosis, can often be managed without iv fluids or. Oct 06, 2017 instead, he had a condition called hyperosmolar hyperglycemic state, or hhs. Common mostly type i dm younger 18meql poor compliance general malaise high blood. Department of health and human services hmis homeless management information systems hud u. 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. Sri mokshagundam is an associate professor on faculty with the university of louisville in the department of endocrinology, metabolism, and diabetes. Patients with sc insulin pump safer to disconnect pump, start iv insulin for mild dka, interrogate pumpflow issue, may discuss with endocrinologist 7. Human resources manual hhs instructions 4511 material. Nov 02, 2009 this presentation was present by my friend during emergency posting seminar with dr.
Busted knowledge into our heads, then was gone like a frat boy bearing rufees, it seems the whole thing is getting seriously drawn out. Adobe tagged pdf hhs making files accessible va pdf tagging tutorial webaim pdf accessibility. 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. Mneumonics mnemonics maybe these will come in handy in nursing school helpful nursing mnemonics fluid imbalance, ss of bleeding, etc. Hyperosmolar hyperglycemic state how to manage your.