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what is hhnc

by Mrs. Madaline Altenwerth MD Published 3 years ago Updated 3 years ago

Hyperglycemic hyperosmolar
Hyperglycemic hyperosmolar
Hyperosmolar hyperglycemic state (HHS) is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Onset is typically over days to weeks.
https://en.wikipedia.org › Hyperosmolar_hyperglycemic_state
nonketotic syndrome (HHNS) is an emergency that the diabetes mellitus (DM) patient may experience. The condition is also commonly referred to as hyperglycemic hyperosmolar nonketotic coma (HHNC).
Mar 24, 2008

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Clinical Features and Diagnosis. The diagnosis of HHNC is relatively straightforward. Pitfalls include the lack of a history of diabetes and the lack of ketosis. Change in mental status, including seizures, and the work-up and treatment of the precipitating disease may temporarily obscure HHNC.

What are the clinical features of hhnc?

HHNC is a severe complication of diabetes mellitus. Diagnosis is predicated on recognizing the typical clinical presentation and confirmed by laboratory findings of profound hyperglycemia and hyperosmolarity, combined with an absence of significant ketosis or acidosis.

What is the pathophysiology of hhnc?

HHNC occurs roughly one-sixth as frequently as does diabetic ketoacidosis (DKA). Up to two-thirds of the patients have no prior history of diabetes, and HHNC is the presenting sign of diabetes. The vast majority of those who do have a history of diabetes have mild Type II disease. 1

What is the prevalence of hhnc in the US?

Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is a potentially deadly condition that can develop as a result of infection or illness in people with uncontrolled type 2 diabetes or when diabetes medications aren't taken as directed. Some also refer to this as a "diabetic coma."

What does HHNS stand for?

Whats the difference between DKA and HHNC?

DKA typically evolves within a few hours, whereas HHNS is much slower and occurs over days to weeks, according to 2021 research . The two conditions look similar because of the hyperglycemia component of each condition. Knowing the symptoms of each can help you seek medical care as soon as possible.

What's the difference between DKA and HHS?

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. The precipitating factors, clinical features, evaluation, and diagnosis of DKA and HHS in adults will be reviewed here.

What does hyperosmolar mean?

The loss of water also makes the blood more concentrated than normal. This is called hyperosmolarity. It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances. This draws the water out of the body's other organs, including the brain.

What is HHS in diabetes?

Overview. Diabetic hyperosmolar (hi-pur-oz-MOE-lur) syndrome is a serious condition caused by extremely high blood sugar levels. The condition most commonly occurs in people with type 2 diabetes. It's often triggered by illness or infection.

Which is worse HHS or DKA?

Hyperosmolar hyperglycemic state (HHS) is one of two serious metabolic derangements that occur in patients with diabetes mellitus (DM). It is a life-threatening emergency that, although less common than its counterpart, diabetic ketoacidosis (DKA), has a much higher mortality rate, reaching up to 5-10%.

Why is HHS worse than DKA?

Lack of ketosis likely is due to only a relative, rather than an absolute, lack of insulin, which reduces the development of ketones. Because HHS typically occurs in older individuals with underlying comorbidities, it has a significantly higher mortality rate than DKA.

What is hyperosmolar dehydration?

What is hyperosmolar hyperglycemic syndrome (HHS)? Hyperosmolar hyperglycemic syndrome (HHS) is a serious complication of diabetes mellitus. HHS occurs when a person's blood glucose (sugar) levels are too high for a long period, leading to severe dehydration (extreme thirst) and confusion.

Is hyperosmolar and hypertonic the same thing?

"Hyperosmolarity- abnormally increased osmotic concentration of a solution. hypertonic 1. pertaining to or characterized by an increased tonicity or tension. 2.

Why is Hyperosmolarity a problem?

This hyperosmolarity can be a problem for patients with SBS who do not contain enough length of small bowel to allow mixing of semielemental and elemental formulations with gut secretions to create a lower osmolarity nutrient mixture for easier absorption.

Do you give insulin in HHS?

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.

What is the treatment for HHS?

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.

How do you diagnose HHS?

Hyperosmolar hyperglycemic state is diagnosed by blood tests that show very high levels of glucose and very concentrated blood. Treatment is intravenous fluids and insulin. Complications include coma, seizures, and death.

What is a HHNS?

HHNS is a relatively rare complication of diabetes, accounting for just 1% of hospital admissions among people with diabetes. 1 . HHNS is sometimes referred to by other names: Hyperglycemic hyperosmolar nonketotic coma (HHNK) Nonketotic hyperosmolar syndrome (NKHS) Diabetic hyperosmolar syndrome. Diabetic HHS.

What is HHNS in diabetes?

Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is a potentially deadly condition that can develop as a result of infection or illness in people with uncontrolled type 2 diabetes or when diabetes medications aren't taken as directed. Some also refer to this as a "diabetic coma.".

Why does HHNS happen?

This dehydration occurs because elevated levels of glucose cause blood to become thicker and result in the body needing to produce more urine in order to lower them. 3 .

How to tell if you have HHNS?

The symptoms of HHNS may appear slowly, taking days or even weeks to fully develop. Common symptoms include: 2 1 Blood glucose levels over 600 milligrams per deciliter (mg/dl) 2 Frequent urination 3 Extreme thirst 4 Dry mouth 5 Confusion or sleepiness 6 Skin that is warm and dry without sweating 7 Fever (usually over 101 F) 8 Weakness or paralysis on one side of the body 9 Loss of vision 10 Hallucinations

How to prevent HHNS?

The best way to prevent HHNS is by keeping your blood sugar levels under control. Test them regularly using a glucometer, work with your doctor to make sure you're taking any diabetes medications as prescribed, and learn the warning signs of elevated glucose levels and dehydration, such as extreme thirst and frequent urination, so you know to seek treatment when you need it. Educate your loved ones and coworkers to also recognize the early signs of blood sugar imbalance, so they can send for help, too.

How to diagnose HHNS?

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. Serum osmolality, a test that measures the body's water/electrolyte balance , also is used to diagnose HHNS.

Does HHNS produce ketones?

When stored fat is used for energy it creates a toxic waste product called ketones, which can poison the body. HHNS does not produce ketones, and the symptoms of DKA are different, including: 8 . Breath that has a fruity odor.

Symptoms of HONK

Before loss of consciousness and coma takes place, patients will display signs of very high blood sugar levels which may include:

Causes of HONK

Causes of hyperglycaemic hyperosmolar non-ketotic coma may include undiagnosed type 2 diabetes that has been developing over a number of years.

Treatment for HONK

Treatment for hyperglycaemic hyperosmolar non-ketotic coma will include fluids being given to the patient and insulin administered intravenously.

HONK and type 2 diabetes

Hyperglycaemic hyperosmolar non-ketotic coma is coma resulting from very high blood glucose levels in a patient with normal ketone levels.

What is HHC, anyway?

HHC was first created in 1944 by the American chemist Roger Adams, when he added hydrogen molecules to Delta-9 THC. This process, known as hydrogenation, converts THC to hexahydrocannabinol (HHC).

How is HHC made?

It’s a many-step process. First, CBD is extracted from raw hemp, distilled and isolated in a powder form. From there, things get a little more complicated.

Is it safe to make HHC?

Richard Sams, scientific director at KCA Laboratories in Nicholasville, Kentucky, has tested HHC products in the past few months (including, incidentally, Bearly Legal’s). He told Leafly HHC can be produced safely in a well-equipped laboratory. But if you scale up production, he said, the risks rise, too.

What are the effects of HHC on the body and mind?

There is a lack of consensus around HHC’s potency.

How potent is HHC?

Kyle Ray, of Colorado Chromatography, told Leafly that while the ratios of the active and inactive HHC molecules can vary from batch to batch, they need to be at least 50% active to pass muster.

Does HHC show up on a drug test?

Burns, of Bearly Legal, believes that some of HHC’s appeal stems from evidence suggesting that it can evade drug tests. But—and this is important—he acknowledges the evidence is only anecdotal. This is just what he’s hearing from his customers.

Is HHC safe to consume?

Like any of the new hemp-derived cannabinoids, there is no standard dose and little to no research on the immediate or long-term effects of HHC ingestion.

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by Glenn C. Freas, MD, JD, FACEP

Pathophysiology

  • HHNC can be thought of as a combination of pancreatic and renal insufficiency precipitated by the causes listed above. Ordinarily, patients with hyperglycemia respond with an increase in insulin secretion. Since older patients are more likely to have pancreatic beta-cell insufficiency, this response may be inadequate. Physiologic stressors or precipitants of HHNC cause an incre…
See more on reliasmedia.com

Clinical Features and Diagnosis

  • The diagnosis of HHNC is relatively straightforward. Pitfalls include the lack of a history of diabetes and the lack of ketosis. Change in mental status, including seizures, and the work-up and treatment of the precipitating disease may temporarily obscure HHNC. Nonetheless, as sick as these patients are (they almost always look sick enough to get lab tests), and with the ready ava…
See more on reliasmedia.com

Treatment

  • After addressing any airway and breathing problems, and treating seizures with benzodiazepines if necessary, the next priority is to establish reliable intravenous access that will allow for aggressive volume resuscitation. Whether they present in shock or not, patients with HHNC are severely volume depleted, and virtually all should get normal saline solution as their initial IV flui…
See more on reliasmedia.com

Summary

  • HHNC is a severe complication of diabetes mellitus. Diagnosis is predicated on recognizing the typical clinical presentation and confirmed by laboratory findings of profound hyperglycemia and hyperosmolarity, combined with an absence of significant ketosis or acidosis. Therapy is directed at aggressive fluid and electrolyte replacement and treatmen...
See more on reliasmedia.com

References

  • 1. Pope DW, et al. Hyperosmolar hyperglycemic nonketotic coma. Emerg Med Clin North Am1989;7:849-857. 2. Podolsky S. Hyperosmolar nonketotic coma in the elderly diabetic. Med Clin North Am1978;4:815-828. 3. Brody GM. DKA and HHNC. Top Emerg Med1992;14:18-20. 4. Gerich JE, et al. Clinical and metabolic characteristics of hyperosmolar nonketotic coma. Diabet…
See more on reliasmedia.com

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      • 28. /vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:45
      • 29. /vendor/laravel/framework/src/Illuminate/Routing/Route.php:261
    • select `id`, `post_title`, `slug` from `posts` where `status` = 'publish' and `posts`.`deleted_at` is null order by RAND() limit 10
      2.25s/app/View/Composers/SidebarView.php:22receivinghelpdeskask
      Metadata
      Bindings
      • 0. publish
      Backtrace
      • 14. /app/View/Composers/SidebarView.php:22
      • 15. /app/View/Composers/SidebarView.php:12
      • 16. /vendor/laravel/framework/src/Illuminate/View/Concerns/ManagesEvents.php:124
      • 17. /vendor/laravel/framework/src/Illuminate/View/Concerns/ManagesEvents.php:162
      • 20. /vendor/laravel/framework/src/Illuminate/View/Concerns/ManagesEvents.php:177
    • select * from `fake_users` where `fake_users`.`id` = 43595 limit 1
      550μsview::2dd102cf0462e89a4d4d8bc77355d767652bf9aa:15receivinghelpdeskask
      Metadata
      Bindings
      • 0. 43595
      Backtrace
      • 21. view::2dd102cf0462e89a4d4d8bc77355d767652bf9aa:15
      • 23. /vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:108
      • 24. /vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 25. /vendor/livewire/livewire/src/ComponentConcerns/RendersLivewireComponents.php:69
      • 26. /vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:61
    App\Models\FakeUser
    1
    Outl1ne\MenuBuilder\Models\MenuItem
    1
    Outl1ne\MenuBuilder\Models\Menu
    1
    App\Models\JsonPostContent
    1
    App\Models\Post
    11
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        _previous
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        _flash
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        PHPDEBUGBAR_STACK_DATA
        []
        path_info
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        status_code
        200
        
        status_text
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        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
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        request_server
        0 of 0
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