Request pdf on may 1, 2007, bumin dundar and others published hyperosmolar nonketotic syndrome in a child associated with lasparaginase and prednisolone find, read and cite all the research. This syndrome is characterised by severe hyperglycaemia, a marked increase in serum osmolality, and clinical evidence of dehydration without significant accumulation of ketoacids. Mar 06, 2012 introduction hyperosmolar hyperglycemic state hhs and diabetic ketoacidosis dka represent two distinct metabolic derangements manifested by insulin deficiency and severe hyperglycemia dka is defined as the presence of all three of the following. Treatment of hyperglycaemic hyperosmolar nonketotic syndrome. Diabetic ketoacidosis v hyperglycemic hyperosmolar nonketotic syndrome hhnk cause. Hyperglycaemic, hyperosmolar, nonketotic hhnk syndrome in. An atypical presentation of hyperosmolar nonketotic coma article pdf available in journal of medical sciences 242. Genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. What is the difference between diabetic ketoacidosis and. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Management of hyperglycemic crises in patients with diabetes.
Sindrome hiperglucemico hiperosmolar no cetoacidotico hhnc en perros diabeticos. Nonketotic diabetic coma has emerged as a distinct syndrome mediated by the hyperosmolarity of the blood. At the time of admission, the patient was semicomatose with a mild right hemiparesis. Hyperosmolar syndrome or diabetic hyperosmolar syndrome is a medical emergency caused by a very high blood glucose level the prefix hyper means high, and osmolarity is a measure of the concentration of active particles in a solution, so the name of the syndrome simply refers to the high concentration of glucose in the blood. However, the terminology was changed because coma is found in fewer than 20% of patients with hhs. Complications may include seizures, disseminated intravascular coagulopathy. Nonketotic hyperosmolar diabetic coma in downs syndrome. Symptoms of honk before loss of consciousness and coma takes place, patients will display signs of. Hyperglycaemic hyperosmolar nonketotic coma is a dangerous condition brought on by very high blood glucose levels in type 2 diabetes above 33 mmoll.
Links to pubmed are also available for selected references. Typically, the patient, a middleaged or old person with diabetes mellitus of recent onset or without previous history of the disease, lapses into stupor and unconsciousness after manifesting prodromal neurological symptoms, such as. Hyperosmolar hyperglycemic state is a relatively common, lifethreatening endocrine emergency that is reported in all age groups,1 but it most frequently affects older patients with type 2 diabetes. Get a printable copy pdf file of the complete article 414k, or click on a page image below to browse page by page. Diabetic coma australia pdf ppt case reports symptoms. In modern medical practice, it rarely takes more than a few questions, a quick look, and a glucose meter to determine the cause of unconsciousness in a patient with diabetes. Usually, hhns is brought on by an illness or infection. Olanzapineinduced hyperglycaemic coma and neuroleptic malignant syndrome. Hypoglycemia occurs when you dont have enough glucose sugar in your body. Hyperosmolar hyperglycemic nonketotic coma definition of. Komplikasi dm hyperglycemia hypoglycemia free 30day. The hyperglycemic hyperosmolar syndrome hhs is a lifethreatening diabetic complication. Hhns is typically observed in elderly patients with noninsulindependent diabetes.
The incidence and risk factors for diabetic ketoacidosis diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome hyperglycemic hyperosmolar syndrome, previously called nonketotic hyperosmolar coma have not been reported in a national population of renal transplant renal transplantation recipients. Arieff and carrolls diagnostic criteria included a blood glucose level. If you have problems viewing pdf files, download the latest version of adobe reader. Hyperosmolar nonketotic diabetic syndrome precipitated by treatment with diuretics. The condition is characterized by hyperglycemia, hyperosmolarity, and an ab. Severe hyperglycemic hyperosmolar nonketotic coma in a nondiabetic patient receiving aripiprazole.
Intravenous fluid replacement is similar to that administered in diabetic ketoacidosis dka and. Diabetic coma is a reversible form of coma found in people with diabetes mellitus. With the correct treatment and recommended lifestyle changes, many people with diabetes are able to prevent or delay the onset of complications. Diabetic hyperglycemic hyperosmolar syndrome hhs is a complication of type 2 diabetes. The primary goal of treatment in hyperglycemic hyperosmolar nonketotic syndrome hhns is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Hyperosmolar hyperglycemic state hhs endocrine and. Type 2 diab w hyprosm wo nonket hyprglyhypros coma nkhhc the 2020 edition of icd10cm e11. She complained of acute onset of bilateral limb involuntary activities, and being easy to fall within a week. Two cases of hyperosmolar nonketotic coma with neurological disorders are presented.
Mar 27, 2014 a 12 yrold child without any past medical history of diseases was admitted to hospital for sopor and polyuria. Hyperosmolar nonketotic coma synonyms, hyperosmolar nonketotic coma pronunciation, hyperosmolar nonketotic coma translation, english dictionary definition of hyperosmolar nonketotic coma. Healthcare cost and utilization project, state inpatient database. Sindrome hiperglucemico hiperosmolar no cetoacidotico hhnc. Some of the symptoms seen in diabetic ketoacidosis are vomiting, abdominal pain, dehydration, an acetone odor on the breath, and change in sensorium mccance et al.
Clinical case study hyperosmolar hyperglycaemic syndrome. In the article dealing with hyperosmolar, nonketotic syndrome and steroid diabetes after renal transplantation p 1261, the authors describe a seriously ill patient with a plasma glucose level of 1,526 mg100 ml and near coma, without ketosis. 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 hyperosmolar hyperglycemic nonketotic syndrome hhns, also known as hyperosmolar hyperglycaemic state hhs is a dangerous condition resulting from very high blood glucose levels. Hhns is an emergency caused by very high blood sugar, often over 600 mgdl. The management of the hyperosmolar hyperglycaemic state. Hhnk syndrome is characterized by extremely high blood glucose levels. These labels include hyperosmolar nonketotic coma, hyperosmolar hyperglycemic nonketotic coma, and hyperglycemic hyperosmolar nonketotic syndrome hackel, 2014. Agency for healthcare research and quality, rockville, md. If you have problems viewing pdf files, download the latest version of adobe reader for language access assistance, contact the ncats public information officer genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. Although there are some important differences, the pathophysiology, the presenting clinical challenge, and the treatment of these metabolic derangements are similar. May 08, 2017 the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Pdf an atypical presentation of hyperosmolar nonketotic.
Questions and answer part case study glycaemic status question blood glucose monitoring has been an important tool in the effective management of outpatients with diabetes. Nonketotic hyperosmolar diabetic coma is a rare manifestation of juvenile diabetes, in contrast to adult onset diabetes. This molecule is an amino acid, which is a building block of proteins. Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine. This is a unique case of nonketotic hyperglycemic nkh chorea in 84yearold asian woman. Diabetic ketoacidosis and hyperglycemic hyperosmolar.
Continuous hyperosomolar therapy for traumatic braininjured. Hyperosmolar hyperglycemic state hhs is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Hyperosmolar nonketotic coma synonyms, hyperosmolar nonketotic coma pronunciation, hyperosmolar nonketotic coma translation, english dictionary definition of hyperosmolar nonketotic. Nonketotic hyperglycemic chorea this is an open access article distributed under the creative commons attribution license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Hyperosmolar nonketotic diabetic syndrome precipitated by. Hyperosmolar hyperglisemic nonketotic coma honkc is a rare complication of type 2 diabetes mellitus dm. For language access assistance, contact the ncats public information officer. Hyperosmolar nonketotic coma how is hyperosmolar non. Hospitalizations with diabetesassociated conditions. Bun, crt, osmolarity bc dehydration metabolic acidosis. Although the national estimates are reported at the annual level, the years of data vary across states 20112014. Oct 27, 2012 hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. Browse az genetic and rare diseases information center.
To date only 20 cases have been published, the majority of them infants and toddlers. Hyperosmolar nonketotic syndrome in a child associated with. Diabetes increases your risk for many serious health problems. The osmolality and sodium initially increased to 176 mmoll and 408 mosmkg. The diagnosis and management of hhs presents a challenge in paediatric patients who may present with a mixed picture of hhs and diabetic ketoacidosis dka. This tool which entails self monitoring of blood glucose level in a specified period has been designed to help in glycaemic control and lowered the risk associated with high blood sugar level. Click on any term below to browse the alphabetical index. The incidence of diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome were 33.
This draws the water out of the bodys other organs, including the brain. Hhns can affect both types of diabetics, yet it usually occurs amongst people with type 2 diabetes. Introduction hyperosmolar hyperglycemic state hhs and diabetic ketoacidosis dka represent two distinct metabolic derangements manifested by insulin deficiency and severe hyperglycemia dka is defined as the presence of all three of the following. Hyperglycaemic, hyperosmolar nonketotic hhnk syndrome is an uncommon complication of untreated canine diabetes. However, the signal intensity in putamenal and cerebellum lesion on mr imaging, which is believed to be pathogenetically related to hemichorea, is rarely documented in. He was rehydrated with hypotonic saline and treated with insulin. Consumer reports ranks excelas cardiothoracic surgical program among the nations best with the excela health physician practice of cardiothoracic surgical associates ranking among the top 10 percent nationally, receiving the highest rating from the society of. It involves extremely high blood sugar glucose level without the presence of ketones. Full text full text is available as a scanned copy of the original print version. Hhns can affect both types of diabetics, yet it usually occurs amongst people with type 2 diabetes usually, hhns is brought on by an illness or infection.
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%. Jan 14, 2019 hyperosmolar hyperglycemic state hhs is one of two serious metabolic derangements that occur in patients with diabetes mellitus dm. Case report a 28monthold boy presented at midnight with a 2 day history of mild diarrhea, vomiting, lethargy, and progressive muscle weakness. The included conditions are congestive heart failure, stroke, myocardial infarction, lower extremity amputations, hyperosmolar hyperglycemic nonketotic syndrome, diabetic ketoacidosis, and hypoglycemia. Polyuric dehydration caused by di can lead to honkc. Hhns is typically observed in elderly patients with noninsulin. Hyperglycaemic hyperosmolar nonketotic coma is a short term complication requiring immediate treatment by a healthcare professional.
T u r e reports a number of cases of nonketotic hyperglycemic coma in the pediatric age group, 3 in children with downs syndrome. Heart services at excela health have been recognized by national, regional and local groups and include. Glycine encephalopathy, which is also known as nonketotic hyperglycinemia or nkh, is a genetic disorder characterized by abnormally high levels of a molecule called glycine. Hyperglycaemic, hyperosmolar, nonketotic hhnk syndrome. Hyperosmolar nonketotic coma at the onset of type i diabetes. Get a printable copy pdf file of the complete article. Hyperosmolar hyperglycemic nonketotic coma hhnc is a metabolic derangement that occurs principally in patients with adultonset diabetes. Full text is available as a scanned copy of the original print version. The hyperglycemic hyperosmolar state hhs or hyperglycemic hyperosmolar nonketotic coma hhnk is a serious and potentially lethal acute complication of diabetes. Glycine also acts as a neurotransmitter, which is a chemical messenger that transmits signals in the brain. Severe insulin deficiency only in type 1 diabetes cause. Hyperosmolar hyperglycemic state linkedin slideshare.
Glycine encephalopathy genetics home reference nih. Hhs has been known by several other names in the past. The patient had a history of type 2 diabetes mellitus more than 30 years, but had a poor control of blood sugar. Get a printable copy pdf file of the complete article 747k, or click on a page image below to browse page by page. People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome hhns.
Blood glucose was 72 mmoll, sodium 154 mmoll, osmolarity 381 mosmkg, urinary ketons were negative. Hemichorea with corresponding putamenal t1 hyperintensity and t2 hypointensity on mr imaging has occasionally been reported in diabetes mellitus with nonketotic hyperglycemia. One was a 49yearold male, who was admitted because of a brain contusion and a traumatic subarachnoid hemorrhage. The management of the hyperosmolar hyperglycaemic state in adults with diabetes.
Hyperosmolar diabetic coma ketotic and nonketotic jama. The three main causes of the diabetes coma is severe low blood sugar hypoglycemia in type 1 diabetes, diabetic ketoacidosis dka, diabetic hyperosmolar nonketotic syndrome in type 2 diabetes. Hyperglycaemic hyperosmolar nonketotic syndrome hhns is a lifethreatening complication of uncontrolled diabetes mellitus. 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 nonketotic honk coma is a syndrome characterized by extreme elevations in serum glucose concentrations, hyperosmolality and dehydration without significant ketosis 1,2. Hyperglycemic hyperosmolar nonketotic syndrome hhns was infrequently diagnosed till recently. It is firstly suggested that an insulinised liver reflecting residual betacell secretory activity coexists with a diabetic periphery, thereby inactivating intrahepatic oxidation of incoming free fatty acids, which are directed largely along nonketogenic metabolic. It is a condition in which the blood has a high concentration of salt sodium, glucose, and other substances. Two concepts are advanced to explain some of the puzzling biochemical features found in nonketotic hyperosmolar diabetic coma. Hyperosmolar nonketotic coma how is hyperosmolar nonketotic coma abbreviated. Hyperosmolar hyperglycemic nonketotic hhnk syndrome is a clinical syndrome of severe hyperglycemia, hyperosmolarity, and intracellular dehydration without ketoacidosis 1. Hyperglycemic hyperosmolar state hhs is an acute complication associated with diabetes mellitus. The loss of water also makes the blood more concentrated than normal. Buildup of ketones in the body ketoacidosis may also occur.
410 165 1624 431 1010 1618 920 301 1544 368 1585 387 16 179 1042 58 1231 1233 996 309 1251 179 1206 852 1411 432 1090 1027 677 1581 928 478 1293 1427 848 1414 1303 808 987 67 104 329 1145 380