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What is the primary difference between DKA and HHNS?

What is the primary difference between DKA and HHNS?

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.

When differentiating DKA from HHS what lab value will assist in diagnosis?

The resolution of DKA is reached when the blood glucose is < 200 mg/dl, serum bicarbonate is ≥15 mEq/L, pH is >7.30 and anion gap is ≤12 mEq/L (17). HHS is resolved when serum osmolality is < 320 mOsm/kg with a gradual recovery to mental alertness.

How is HHNS diagnosed?

Diagnosis. 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.

What gap indicates DKA?

In mild DKA, anion gap is greater than 10 and in moderate or severe DKA the anion gap is greater than 12. These figures differentiate DKA from HHS where blood glucose is greater than 600 mg/dL but pH is greater than 7.3 and serum bicarbonate greater than 15 mEq/L.

What are the symptoms of HHNS?


  • Blood glucose levels over 600 milligrams per deciliter (mg/dl)
  • Frequent urination.
  • Extreme thirst.
  • Dry mouth.
  • Confusion or sleepiness.
  • Skin that is warm and dry without sweating.
  • Fever (usually over 101 F)
  • Weakness or paralysis on one side of the body.

Why is sodium low in DKA?

In DKA, we expect to find normal or low serum sodium due to the dilutional effect of hyperosmolar status caused by elevated blood glucose that shifts water from the intracellular space to the extracellular space.

Why is glucose so much higher in HHS than DKA?

In addition, DKA patients tend to be younger than HHS patients, and thereby have a higher glomerular filtration rate. Accordingly, DKA patients have a greater ability to excrete glucose in urine and can thereby limit the hyperglycemia.

Does HHS have an anion gap?

The calculated anion gap in HHS is usually within normal limits (8-12 mmol/L). A wide anion gap can be observed in patients with HHS, reflecting mild metabolic acidosis.

Is HHS and HHNS the same?

Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS), also known as Hyperosmolar Hyperglycaemic State (HHS) is a dangerous condition resulting from very high blood glucose levels. HHNS can affect both types of diabetics, yet it usually occurs amongst people with type 2 diabetes.

Why is potassium high in DKA?

When circulating insulin is lacking, as in DKA, potassium moves out of cells, thus raising plasma potassium levels even in the presence of total body potassium deficiency [2,3].

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