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    Hyperosmolar Hyperglycemic State

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    Ach Najich Rf
    This document discusses hyperosmolar hyperglycemic state (HHS), a life-threatening complication of diabetes mellitus. It covers the terminology, epidemiology, etiology, pathophysiology, clinical presentation, diagnosis, and treatment of HHS. Treatment involves rehydration, management of blood glucose levels and electrolyte imbalances, and treatment of any underlying infections. The goal of treatment is to gradually correct dehydration and hyperglycemia while preventing complications like shock, cardiovascular collapse, and renal failure.

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    Hyperosmolar Hyperglycemic State

    Uploaded by

    Ach Najich Rf
    55 views13 pages
    This document discusses hyperosmolar hyperglycemic state (HHS), a life-threatening complication of diabetes mellitus. It covers the terminology, epidemiology, etiology, pathophysiology, clinical presentation, diagnosis, and treatment of HHS. Treatment involves rehydration, management of blood glucose levels and electrolyte imbalances, and treatment of any underlying infections. The goal of treatment is to gradually correct dehydration and hyperglycemia while preventing complications like shock, cardiovascular collapse, and renal failure.

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    This document discusses hyperosmolar hyperglycemic state (HHS), a life-threatening complication of diabetes mellitus. It covers the terminology, epidemiology, etiology, pathophysiology, clinical presentation, diagnosis, and treatment of HHS. Treatment involves rehydration, management of blood glucose levels and electrolyte imbalances, and treatment of any underlying infections. The goal of treatment is to gradually correct dehydration and hyperglycemia while preventing complications like shock, cardiovascular collapse, and renal failure.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    55 views13 pages

    Hyperosmolar Hyperglycemic State

    Uploaded by

    Ach Najich Rf
    This document discusses hyperosmolar hyperglycemic state (HHS), a life-threatening complication of diabetes mellitus. It covers the terminology, epidemiology, etiology, pathophysiology, clinical presentation, diagnosis, and treatment of HHS. Treatment involves rehydration, management of blood glucose levels and electrolyte imbalances, and treatment of any underlying infections. The goal of treatment is to gradually correct dehydration and hyperglycemia while preventing complications like shock, cardiovascular collapse, and renal failure.

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    HYPEROSMOLAR HYPERGLYCEMIC

    STATE

    Ach Najich RF, dr.


    Terminologi

    • KHONK ( KOMA HIPEROSMOLAR NON


    KETOTIK)
    • HHNK (HIPERGLIKEMI HIPEROSMOLAR
    NONKETOTIK KOMA)

    • Terminologi diatas pada saat ini telah berubah


    karena koma hanya ditemukan <20% kasus
    HHS
    Epidemiologi

    • Hyperosmolar hyperglycemic state (HHS) is 1 of


    2 serious metabolic derangements that occurs
    in patients with diabetes mellitus (DM) and can
    be a life-threatening emergency . 1
    • Secara Keseluruhan Insiden HHS 1 kasus/1000
    penduduk dalam 1 tahun. (USA 1989-1991). 2
    • Rata-rata pasien HHS terdiagnosa pada
    beberapa laporan kasus berusia 57-69 tahun. 2
    Etiologi

    • DM TIPE 2
    • Fluid Intake
    • Major Ilness
    • Stress Response
    • Abused/ Neglected in older Patient
    Insulin Deficiency

    Hyperglycemia

    Hyper-
    osmolality
    Glycosuria

    Δ MS
    Dehydration

    Electrolyte
    Renal Failure Losses

    Shock CV
    Collapse 5
    Hyperosmolar Hyperglycemic State:
    Pathophysiology

    Unchecked gluconeogenesis  Hyperglycemia

    Osmotic diuresis  Dehydration

    • Presents commonly with renal failure


    • Insufficient insulin for prevention of hyperglycemia but
    sufficient insulin for suppression of lipolysis and ketogenesis
    • Absence of significant acidosis
    • Often identifiable precipitating event (infection, MI)

    6
    Clinical Presentation

    • Compared to DKA, in HHS there is greater


    severity of:
    – Dehydration
    – Hyperglycemia
    – Hypernatremia
    – Hyperosmolality
    • Because some insulin typically persists in HHS,
    ketogenesis is absent to minimal and is
    insufficient to produce significant acidosis
    Clinical Presentation of
    Hyperglycemic Hyperosmolar State

    Patient Profile Disease Characteristics


    • Older • More insidious development
    • More comorbidities than DKA (weeks vs
    • History of type 2 diabetes, hours/days)
    which may have been • Greater osmolality and mental
    unrecognized status changes than DKA
    • Dehydration presenting with a
    shock-like state

    8
    Diagnosis

    • Plasma glucose level of 600 mg/dL or greater


    • Effective serum osmolality of 320 mOsm/kg or
    greater
    • Profound dehydration, up to an average of 9L
    • Serum pH greater than 7.30
    • Bicarbonate concentration greater than 15
    mEq/L
    • Small ketonuria and absent-to-low ketonemia
    • Some alteration in consciousness
    Differential Diagnosis

    • KAD ( Ketoasidosis Diabetes)


    Treatment
    Fase I 1. Rehidrasi: Nacl 0,9% / RL 2 liter/ 2
    jam, 80 tts/mt 4 jam, 30 tts/mt 18
    jam, 20 tts/mt 24 jam.

    2. IDRIV: minus satu


    3. K: 25 meq (3-35) dst
    4. Bikarbonat:
    pH≤7,2-7,3 50-100 meq drip dlm 2 j BIK
    <12 20 tts/mt
    pH < 7 25 meq bolus sisanya 20 ttsx/mt
    5. Antibiotik
    Glukosa +/- 250 mg/dl atau reduksi ±
    Fase II 1. Maintenance: Nacl 0,9% Potacol R ( RI
    4U - 8U ) , Maltosa 10% (RI6-12U)
    bergantian 20 tts/mt (start slow, go slow,
    stop slow)
    2. K < 4 parenteral, per os dg air tomat/
    kaldu
    3. RI: rumus kali dua
    4. Makanan lunak:KH kom pleks per-os
    Fase I 1. Rehidrasi: Kadar
    Na < 150 meq :
    Nacl 0,9% ; Na >
    150 meq pakai
    Nacl 0,45%;
    Rumus sama: 2
    liter/ 2 jam, 80
    tts/mt 4 jam, 30
    tts/mt 18 jam,
    20 tts/mt 24
    jam.
    2. IDRIV: minus satu
    3. K: 25 meq (3-35) dst
    4. Antibiotik
    Glukosa +/- 250 mg/dl atau reduksi ±
    Fase II 1. Maintenance: Nacl
    0,9% Potacol R ( RI 4U -
    8U ) , Maltosa 10% (RI6-
    12U) bergantian 20
    tts/mt (start slow, go
    slow, stop slow)
    2. K < 4 parenteral, per
    os dg air tomat/ kaldu
    3. RI: rumus kali dua
    4. Makanan lunak:KH
    kom pleks per-os
    Refference

    • 1. Pasquel FJ, Umpierrez GE. Hyperosmolar


    hyperglycemic state: a historic review of the
    clinical presentation, diagnosis, and treatment.
    Diabetes Care. 2014 Nov. 37 (11):3124-31.
    [Medline]

    • 2. Nugent BW. Hyperosmolar hyperglycemic


    state. Emerg Med Clin North Am. 2005 Aug.
    23(3):629-48,

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