Differentiating Between DKA and HHS

Lenahan, Christy McDonald; Holloway, Brenda

doi:10.1016/j.jen.2014.08.015

Cited by 4 publications

(19 citation statements)

References 19 publications

(61 reference statements)

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“…Although the hospital admission rate for HHS is lower than DKA and less than 1% of all diabetic-related admissions, HHS's mortality rate is higher than DKA, and it can exceed 40%, compared to DKA mortality, which is less than 5% [1,3,4] . Previous studies concluded that HHS mortality is higher in females and older patients (above the 60s) and at diabetic onset [1] .…”

Section: Introductionmentioning

confidence: 92%

“…Hypothetically, patients with combined HHS and DKA have more critical outcomes than patients with isolated DKA or HHS alone [2] . Concomitant and/or differential diagnose must be evaluated in a patient with HHS, include diabetes insipidus, DKA, myocardial infarction, and pulmonary embolism [4] . Patients with DKA or diabetes insipidus may present with similar HHS symptoms, such as polydipsia and polyuria [4] .…”

Section: Introductionmentioning

confidence: 99%

“…Concomitant and/or differential diagnose must be evaluated in a patient with HHS, include diabetes insipidus, DKA, myocardial infarction, and pulmonary embolism [4] . Patients with DKA or diabetes insipidus may present with similar HHS symptoms, such as polydipsia and polyuria [4] . Myocardial infarction and pulmonary embolism are risk factors for HHS, and laboratory investigations must be assessed for every HHS patients individually to evaluate for an accurate diagnosis [4] .…”

Section: Introductionmentioning

confidence: 99%

“…Patients with DKA or diabetes insipidus may present with similar HHS symptoms, such as polydipsia and polyuria [4] . Myocardial infarction and pulmonary embolism are risk factors for HHS, and laboratory investigations must be assessed for every HHS patients individually to evaluate for an accurate diagnosis [4] . Other differential diagnoses associated with HHS include infection, pregnancy, and ingestion of drugs such as cocaine [4] .…”

Section: Introductionmentioning

confidence: 99%

“…Generally, HHS resulted in poorly controlled diabetes and characterized absolute or relative insulinopenia [3] . Elderly and African American ethnicity have increased risk of HHS development [4] .…”

Section: Introductionmentioning

confidence: 99%

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Hyperosmolar hyperglycemic state management in the emergency department

Alghamdi¹,

Alzahrani²,

Alshams³

et al. 2021

Arch Pharma Pract

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Background: Hyperosmolar hyperglycemic state is an emergency condition characterized by a significant elevation in blood glucose and serum osmolality level with altered sensorium in the absence of significant ketoacidosis. It is commonly found in the elderly population with poorly controlled type 2 diabetes, but it can also be found in children and adolescents. Early recognition is crucial to establish the precipitating factor and to start proper management immediately. Objective: This literature review aims to provide an overview and pathogenesis of hyperosmolar hyperglycemic state and address the necessity of early recognition by the emergency physician and immediate management approach. Methodology: We searched for relevant articles on the topic in the PubMed database. Common Mesh terms were used: Hyperosmolar hyperglycemic state, emergency management, and complications. Conclusion: The backbone treatment restores the large water deficit and correct electrolyte imbalance induced by severe dehydration. Early identifying the precipitating factor is essential, but not to delay in management. Further instructions must be provided to avoid further attack as HHS has a high mortality rate that reaches 40%.

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Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Hyperosmolar hyperglycemic state management in the emergency department

Alghamdi¹,

Alzahrani²,

Alshams³

et al. 2021

Arch Pharma Pract

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Diagnosis and Acute Management of Hyperglycemic Hyperosmolar Syndrome in Children and Adolescents

Kappy,

Lindgren

2023

Pediatr Emer Care

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Hyperglycemic hyperosmolar syndrome (HHS) is an indolent process characterized by significantly increased levels of serum glucose, high osmolality, and electrolyte abnormalities. The incidence of HHS has steadily risen in the pediatric population over the past several years. Patients with HHS often present with profound dehydration, fatigue, and early mental status changes. Primary emergency management of HHS involves fluid replacement, hemodynamic support, correcting electrolyte derangements, and addressing complications and underlying illnesses. Insulin is not an initial therapy in HHS and should be considered only after the patient's fluids and electrolytes have been repleted. Unlike in diabetic ketoacidosis, HHS patients are not acidotic, although children may present with mixed HHS/diabetic ketoacidosis syndromes. Complications of HHS include thrombosis, rhabdomyolysis, and, rarely, malignant hyperthermia.

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Overlap of diabetic ketoacidosis and hyperosmolar hyperglycemic state

Hassan¹,

Mushtaq²,

Mahmoud³

et al. 2022

World J Clin Cases

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Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemia state (HHS) are two life-threatening metabolic complications of diabetes that significantly increase mortality and morbidity. Despite major advances, reaching a uniform consensus regarding the diagnostic criteria and treatment of both conditions has been challenging. A significant overlap between these two extremes of the hyperglycemic crisis spectrum poses an additional hurdle. It has well been noted that a complete biochemical and clinical patient evaluation with timely diagnosis and treatment is vital for symptom resolution. Worldwide, there is a lack of large-scale studies that help define how hyperglycemic crises should be managed. This article will provide a comprehensive review of the pathophysiology, diagnosis, and management of DKA-HHS overlap.

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Differentiating Between DKA and HHS

Cited by 4 publications

References 19 publications

Hyperosmolar hyperglycemic state management in the emergency department

Hyperosmolar hyperglycemic state management in the emergency department

Diagnosis and Acute Management of Hyperglycemic Hyperosmolar Syndrome in Children and Adolescents

Overlap of diabetic ketoacidosis and hyperosmolar hyperglycemic state

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