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Discuss the Pathogenesis, Presentation and Management of HHS

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Discuss the Pathogenesis, Presentation and Management of HHS

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Abstract

Introduction-Hyperosmolar hyperglycaemic state (HHS) classically happens in type 2 diabetes formerly recognised as hyperosmolar non-ketotic (HONK) state. The level of blood glucose can be greater than that is DKA (>50 mmol/litre) however there is no ketone in urine. It is accompanying with severe dehydration and patients necessitate importunate, directed fluid resuscitation, correction of electrolyte disturbances and insulin. The characteristic features of HHS a syndrome are severe hyperglycaemia, hyper osmolality and excessive water loss in the non-appearance of ketoacidosis. Occurrence of HHS among diabetic patients is approximately less than 1%. Higher percentage of cases occur in elder type 2 diabetic patients still, young adult and children are also prone to develop HHS. The mortality rate approximately 20% which is around 10 times DKA mortality rate. The dehydration severity, existence of comorbidities and old age determined the prognosis of HHS. The management of HHS is focussed on correction of volume deficit, hyper osmolality, hyperglycaemia, and electrolyte abnormalities in addition to treating the underlying causes which trigger the metabolic decompensation. Although regime of intravenous low dose insulin meant for mange DKA seem to be effectual, the better therapy approaches for the treatment of HHS have not established by any prospective randomized studies.

References

35 Cites in Article
  1. 1. C Hoy,C Beecroft (2016). The patient with endocrine disease. Surgery
  2. 2. H Fishbein,P Palumbo (1995). Acute metabolic complications in diabetes. Diabetes in America, 283-291.
  3. 3. Arlan Rosenbloom (2010). Hyperglycemic Hyperosmolar State: An Emerging Pediatric Problem. The Journal of Pediatrics, 156(2), 180-184.
  4. 4. H Milionis,M Elisaf (2005). Therapeutic management of hyperglycaemic hyperosmolar syndrome. Expert Opin Pharmacother, 6, 1841-1849.
  5. 5. Gian Fadini,Saula De Kreutzenberg,Mauro Rigato,Stefano Brocco,Maria Marchesan,Antonio Tiengo,Angelo Avogaro (2011). Characteristics and outcomes of the hyperglycemic hyperosmolar non-ketotic syndrome in a cohort of 51 consecutive cases at a single center. Diabetes Research and Clinical Practice, 94(2), 172-179.
  6. 6. Abbas Kitabchi,Guillermo Umpierrez,John Miles,Joseph Fisher (2009). Hyperglycemic Crises in Adult Patients With Diabetes. Diabetes Care, 32(7), 1335-1343.
  7. 7. G Umpierrez,J Kelly,J Navarrete,M Casals,A Kitabchi (1997). Hyperglycemic crises in urban blacks. Arch Intern Med, 157, 669-675.
  8. 8. Francisco Pasquel,Guillermo Umpierrez (2014). Hyperosmolar Hyperglycemic State: A Historic Review of the Clinical Presentation, Diagnosis, and Treatment. Diabetes Care, 37(11), 3124-3131.
  9. 9. Michael Macaulay (1971). Hyperosmolar non-ketotic diabetes. Postgraduate Medical Journal, 47(546), 191-196.
  10. 10. L Luzi,E Barrett,L Groop,E Ferrannini,R Defronzo (1988). Metabolic effects of low-dose insulin therapy on glucose metabolism in diabetic ketoacidosis. Diabetes, 37(11), 1470-1477.
  11. 11. M Chupin,B Charbonnel,F Chupin (1981). C-peptide blood levels in keto-acidosis and in hyperosmolar non-ketotic diabetic coma. Acta Diabetol Lat, 18, 123-128.
  12. 12. Justin Rains,Sushil Jain (2011). Oxidative stress, insulin signaling, and diabetes. Free Radical Biology and Medicine, 50(5), 567-575.
  13. 13. Tom Wachtel,Linda Tetu-Mouradjian,Dona Goldman,Susan Ellis,Patricia O’sullivan (1991). Hyperosmolarity and acidosis in diabetes mellitus. Journal of General Internal Medicine, 6(6), 495-502.
  14. 14. Guillermo Umpierrez,Mary Murphy,Abbas Kitabchi (2002). Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Syndrome. Diabetes Spectrum, 15(1), 28-36.
  15. 15. Abbas Kitabchi,Ebenezer Nyenwe (2006). Hyperglycemic Crises in Diabetes Mellitus: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. Endocrinology and Metabolism Clinics of North America, 35(4), 725-751.
  16. 16. Phil Zeitler,Andrea Haqq,Arlan Rosenbloom,Nicole Glaser (2011). Hyperglycemic Hyperosmolar Syndrome in Children: Pathophysiological Considerations and Suggested Guidelines for Treatment. The Journal of Pediatrics, 158(1), 9-14.e2.
  17. 17. F Coller,W Maddock (1935). A study of dehydration in adults. Annals of Surgery, 947-960.
  18. 18. E Bartoli,L Bergamaco,L Castello,P Sainaghi (2009). Methods for the quantitative assessment of electrolyte disturbances in hyperglycaemia. Nutr Metab Cardiovasc Dis, 19, 67-74.
  19. 19. (2001). American Diabetes Association: Hyperglycemic crises in patients with diabetes mellitus (Position Statement). Diabetes Care, 24, 1988-1996.
  20. 20. E Ennis,Ejvb Stahl,R Kreisburg (1994). Hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Diabetes Rev, 2, 115-126.
  21. 21. P Perel,J Roberts (2011). Colloids vs crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev, 567.
  22. 22. D Van Zyl,P Rheeder,E Delport (2012). Fluid management in diabetic-acidosis--Ringer's lactate versus normal saline: a randomized controlled trial. QJM, 105(4), 337-343.
  23. 23. Junaid Birmingham (2002). To National Patient Safety Agency or not to National Patient Safety Agency: an audit on the current trends in paediatric intravenous fluid prescribing for surgical patients. Archives of Disease in Childhood, 97(5), e9.2-e10.
  24. 24. A Kitabchi,G Umpierrez,M Murphy,E Barrett,R Kreisberg,J Malone,B Wall (2001). Management of hyperglycemic crises in patients with diabetes. Diabetes Care, 24, 31-53.
  25. 25. P English,G Williams (2004). Hyperglycaemic crises and lactic acidosis in diabetes mellitus. Postgrad Med J, 80, 253-261.
  26. 26. Phil Zeitler,Andrea Haqq,Arlan Rosenbloom,Nicole Glaser (2011). Hyperglycemic Hyperosmolar Syndrome in Children: Pathophysiological Considerations and Suggested Guidelines for Treatment. The Journal of Pediatrics, 158(1), 9-14.e2.
  27. 27. Lawrence Morris,Abbas Kitabchi (1980). Efficacy of Low-Dose Insulin Therapy for Severely Obtunded Patients in Diabetic Ketoacidosis. Diabetes Care, 3(1), 53-56.
  28. 28. A Scott (2015). The management of the hyperosmolar hyperglycaemic state in adults with diabetes: a summary of a report from the Joint British Diabetes Societies for Inpatient Care. British Journal of Diabetes, 15(2), 89.
  29. 29. Juan Gutierrez,Rochelle Bagatell,Meredith Samson,Andreas Theodorou,Robert Berg (2003). Femoral central venous catheter-associated deep venous thrombosis in children with diabetic ketoacidosis. Critical Care Medicine, 31(1), 80-83.
  30. 30. R Mannix,M Tan,R Wright,M Baskin (2006). Acute pediatricrhabdomyolysis: causes and rates of renal failure. Pediatrics, 118, 2119-2125.
  31. 31. Abby Hollander,Robert Olney,Piers Blackett,Bess Marshall (2003). Fatal Malignant Hyperthermia-Like Syndrome With Rhabdomyolysis Complicating the Presentation of Diabetes Mellitus in Adolescent Males. Pediatrics, 111(6), 1447-1452.
  32. 32. Brendan Kilbane,Sanjeev Mehta,Philippe Backeljauw,Thomas Shanley,Nancy Crimmins (2006). Approach to management of malignant hyperthermia-like syndrome in pediatric diabetes mellitus. Pediatric Critical Care Medicine, 7(2), 169-173.
  33. 33. Alba Morales,Arlan Rosenbloom (2004). Death caused by hyperglycemic hyperosmolar state at the onset of type 2 diabetes. The Journal of Pediatrics, 144(2), 270-273.
  34. 34. A Rosenbloom (2010). Hyperglycemic hyperosmolar state: an emerging pediatric problem. J Pediatr, 156, 180-184.
  35. 35. Francisco Pasquel,Guillermo Umpierrez (2014). Hyperosmolar Hyperglycemic State: A Historic Review of the Clinical Presentation, Diagnosis, and Treatment. Diabetes Care, 37(11), 3124-3131.

Funding

No external funding was declared for this work.

Conflict of Interest

The authors declare no conflict of interest.

Ethical Approval

No ethics committee approval was required for this article type.

Data Availability

Not applicable for this article.

How to Cite This Article

Ismat Abdelrhman Alborhan Mohammed. 2018. "Discuss the Pathogenesis, Presentation and Management of HHS". Global Journal of Medical Research - F: Diseases GJMR-F Volume 18 (GJMR Volume 18 Issue F1).

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Journal Specifications

Crossref Journal DOI 10.17406/gjmra

Print ISSN 0975-5888

e-ISSN 2249-4618

Keywords
Classification
GJMR-F Classification NLMC Code: QZ 40
Version of record
v1.2

Issue date
April 20, 2018

Language
English
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Discuss the Pathogenesis, Presentation and Management of HHS

Ismat Mohammed
Ismat Mohammed Cardiff university