Diabetic ketoacidosis vs hyperglycemic hyperosmolar nonketotic syndrome (HHNS or HHS): What are the differences between these two complications of diabetes mellitus?
Many students get these two complications confused due to their similarities, but there are major differences between these two complications.
After reviewing this NCLEX review, don’t forget to take the quiz on DKA vs HHNS.
Lecture on DKA and HHS
DKA vs HHNS
- Affects mainly Type 1 diabetics
- Ketones and Acidosis present
- Hyperglycemia presents >300 mg/dL
- Variable osmolality
- Happens Suddenly
- Causes: no insulin present in the body or illness/infection
- Seen in young or undiagnosed diabetics
- Main problems are hyperglycemia, ketones, and acidosis (blood pH <7.35)
- Clinical signs/symptoms: Kussmaul breathing, fruity breath, abdominal pain
- Treatment is the same as in HHNS (fluids, electrolyte replacement, and insulin)
- Watch potassium levels closely when giving insulin and make sure the level is at least 3.3 before administrating.
Hyperglycemic Hyperosmolar Nonketotic Syndrome
- Affects mainly Type 2 diabetics
- No ketones or acidosis present
- EXTREME Hyperglycemia (remember heavy-duty hyperglycemia) >600 mg/dL sometimes four digits
- High Osmolality (more of an issue in HHNS than DKA)
- Happens Gradually
- Causes: mainly illness or infection and there is some insulin present which prevents the breakdown of ketones
- Seen in older adults due to illness or infection
- Main problems are dehydration & heavy-duty hyperglycemia and hyperosmolarity (because the glucose is so high it makes the blood very concentrated)
- More likely to have mental status changes due to severe dehydration due to hyperosmolarity
- Treatments are the same as in DKA, however, fluid administration helps just as much as insulin therapy because of the correction of osmolarlity issue.
- Blood pH will be normal (remember no acidosis as in DKA)
- No Kussmaul breathing and fruity breath (because there is no KETOSIS)
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