Hyperosmolar Hyperglycemic Syndrome
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Article at a Glance
- Hyperosmolar hyperglycemic syndrome is an emergency complication of type 2 diabetes.
- Hyperosmolar hyperglycemic syndrome is characterized by extreme hyperglycemia with little to no ketone bodies.
- Clinicians will learn how to manage hyperosmolar hyperglycemic syndrome.
Hyperglycemic hyperosmolar syndrome (HHS) is the counterpart of diabetic ketoacidosis (DKA). HHS is the emergency complication of type 2 diabetes, while DKA is the emergency complication of type 1 diabetes. In most cases of HHS, a patient with type 2 diabetes experiences a large stressor often caused by a physical illness such as the flu or stomach virus. Some other stressors which may cause HHS are psychological stress, intense grieving, or surgery. When a patient experiences stress, three stress hormones are released: epinephrine, norepinephrine, and cortisol. Cortisol fights inflammation. All three oppose insulin, which increases blood glucose. Type 2 diabetes causes a resistance to insulin in addition to the increased blood glucose, causing major complications. The stress response involves the release of cortisol, epinephrine (adrenaline), and norepinephrine.Etiology and Pathophysiology
Related Video – What is Diabetic Ketoacidosis (DKA)?
Several factors cause type 2 diabetes, including obesity, sedentariness, diet, genetics, and blood pressure. Obesity and a lack of activity are the main factors that cause people to become insulin resistant. The stress, release of stress hormones, and insulin resistance create extreme hyperglycemia. A patient with HHS will likely have a much higher blood glucose level than a patient with DKA. DKA is present in type 1 diabetics, and these patients usually grow up with diabetes. Therefore, they are generally more mindful of blood sugar management and treatment. However, the signs and symptoms of type 2 diabetes are more subtle. A patient may have type 2 diabetes for years and remain undiagnosed. They mistakenly think excess fatigue, thirst, or urination are part of the aging process. Thus, patients with undiagnosed type 2 diabetes may experience HHS and then prolong seeking treatment. A type 1 diabetic knows their levels are off, causing DKA, so they seek treatment more quickly. Read: Diabetic Ketoacidosis (DKA)Insulin Resistance in Type 2 Diabetes
The symptoms of a type 2 diabetic’s hyperglycemia are much more subtle than what is observed in a type 1 diabetic. The symptoms are the three Ps: polyphagia, polyuria, and polydipsia. Hyperglycemia is marked by high glucose levels. In HHS, glucose levels can reach as high as 1500 mg/dL.Signs and Symptoms of Hyperglycemia
Related Video – SIADH vs. Diabetes Insipidus
The following are suggestions for managing hyperosmolar hyperglycemic syndrome.Management of Hyperosmolar Hyperglycemic Syndrome
Hypovolemia has fatal consequences for HHS patients. HHS extraordinarily elevates blood glucose levels, causing hypovolemia. These patients will incessantly urinate. Clinicians must watch for hypovolemia and hypovolemic shock. Fluids are the number one priority for HHS patients. Providers start patients on IV fluids before administering the insulin drip to decrease the blood glucose level. Clinicians will observe some of the same symptoms as DKA, such as the three Ps. Frequent urination may lead to hypovolemia in patients presenting with HHS.The Dangers of Hypovolemia
Ketonuria will not present in HHS patients. Clinicians won’t observe acidosis or the same gastrointestinal (GI) signs and symptoms as presented with DKA. Potassium isn’t a concern with HHS, whereas it is in DKA. It’s still important providers start an insulin drip in patients with HHS, but they won’t have elevated potassium levels.No Ketones in Hyperosmolar Hyperglycemic Syndrome
Providers must watch for low potassium when they start the insulin drip. A patient on continuous IV insulin will have decreased potassium levels, yet the provider’s main concern remains hypovolemic fatality caused by extreme osmotic diuresis. HHS is DKA’s counterpart. It’s a complication of type 2 diabetes, whereas DKA is a complication of type 1. It’s caused by any large stressor in a patient’s life, typically an illness. Clinicians must pay attention to blood glucose levels and potassium levels in patients experiencing an HHS episode.Watch out for Hypokalemia
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