Treatment of HHS
Treatment is 0.9% (isotonic) saline solution at a rate of 15 to 20 mL/kg/hour, for the first few hours. After that, the corrected sodium should be calculated. If the corrected sodium is < 135 mEq/L (< 135 mmol/L), then isotonic saline should be continued at a rate of 250 to 500 mL/hour.
In this regard, are you Acidotic in HHS?
A wide anion gap can be observed in patients with HHS, reflecting mild metabolic acidosis. The mild acidosis in HHS is often multifactorial and results, in part, from the accumulation of minimal ketoacids in the absence of effective insulin activity.
In this way, can HHS lead to DKA?
HHS. The basic underlying mechanism of HHS is a relative reduction in effective circulating insulin with a concomitant rise in counterregulatory hormones. Unlike patients with DKA, most patients with HHS do not develop significant ketoacidosis.
Can you have both DKA and HHS?
Over 30% of patients have features of both DKA and HHS (16) with most recent evidence confirming that about 1 out of 4 patients will have both conditions at the time of presentation with hyperglycemic crisis (18).
Does HHS need insulin drip?
indications: who needs an insulin infusion? Not every patient with HHS necessarily requires an insulin infusion. In many patients, volume resuscitation plus subcutaneous insulin will be perfectly adequate to achieve glycemic control.
Does HHS need insulin?
All patients with HHS require IV insulin therapy; however, immediate treatment with insulin is contraindicated in the initial management of patients with HHS. The osmotic pressure that glucose exerts within the vascular space contributes to the maintenance of circulating volume in these severely dehydrated patients.
How can you tell the difference between HKA and HHS?
DKA usually evolves rapidly. In HHS, there is little or no ketoacidosis and the serum glucose concentration frequently exceeds 1000 mg/dL. HHS usually evolves over a period of several days. Overlap between DKA and HHS occurs in more than one-third of patients.
How do you manage HKA and HHS?
The mainstays of treatment in both DKA and HHS are aggressive rehydration, insulin therapy, electrolyte replacement, and discovery and treatment of underlying precipitating events.
How is HHNS diagnosed?
Diagnosis. HHNS is diagnosed based on symptoms and by measuring blood glucose levels, which can be performed with a finger stick. A blood glucose level of 600 mg/dL and low ketone levels are the main factors for diagnosis of HHNS.
Is blood sugar higher in DKA or HHS?
WHY ARE GLUCOSE LEVELS LOWER IN DKA? DKA patients usually have lower blood sugar levels than HHS patients. One reason is that the acute acidosis in DKA causes distressing symptoms (e.g., nausea, dyspnea, abdominal pain) that encourage patients to seek attention at an earlier stage.
What is HHS vs DKA?
DKA is characterized by ketoacidosis and hyperglycemia, while HHS usually has more severe hyperglycemia but no ketoacidosis (table 1). Each represents an extreme in the spectrum of hyperglycemia.
Why is dextrose given in HHS?
When the plasma glucose level reaches 300 mg/dl, insulin infusion may be reduced to 0.05-0.1 unit/kg/hour and dextrose can be added to the fluids to keep the glucose level between 250-300 mg/dl until hyperosmolality has resolved and the patient is alert.
Why is there no insulin in HHS?
HHS is a potentially life-threatening emergency
Ketones develop when the blood glucose level is high due to lack of insulin which is needed to allow glucose to enter the cells for energy. Because people with Type 2 diabetes may still be producing some insulin, ketones may not be created.