Medical Surgical DKA vs HHS #5

Question

A nurse is trying to explain to a nursing student the differences between diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Which symptom(s) is/are associated with HHS?

Answers

  1. Disorientation
    • Rationale:

      This answer is correct because confusion is associated with HHS, but is not associated with DKA. Hyperglycemic hyperosmolar syndrome (HHS) is a serious complication of type 2 diabetes mellitus. It occurs when a client has extremely high blood glucoses (> 600 mg/dl) for an extended time. The interesting characteristics is there are no elevation of ketones in this situation. The condition leads to serious dehydration, excessive thirst, and confusion. It is often caused or triggered by a recent infection or sickness.

  2. Abdominal pain
    • Rationale:

      This answer is not correct because abdominal pain is not associated with HHS but is associated with DKA. Hyperglycemic hyperosmolar syndrome (HHS) is a serious complication of type 2 diabetes mellitus. It occurs when a client has extremely high blood glucoses (> 600 mg/dl) for an extended time. The interesting characteristics is there are no elevation of ketones in this situation. The condition leads to serious dehydration, excessive thirst, and confusion. It is often caused or triggered by a recent infection or sickness.

  3. Sudden occurrence
    • Rationale:

      This answer is not correct because HHS has a slow, gradual onset compared to the sudden onset of DKA. Hyperglycemic hyperosmolar syndrome (HHS) is a serious complication of type 2 diabetes mellitus. It occurs when a client has extremely high blood glucoses (> 600 mg/dl) for an extended time. The interesting characteristics is there are no elevation of ketones in this situation. The condition leads to serious dehydration, excessive thirst, and confusion. It is often caused or triggered by a recent infection of sickness.

  4. Extreme dehydration
    • Rationale:

      This answer is correct because extreme dehydration is associated with HHS. As the name implies, the client has the symptom of hyperosmolarity, which means the blood is very dense, indicating extreme dehydration. IV fluids would be administered immediately to address this problem. HHS occurs when a type 2 diabetic client has extremely high blood glucoses (> 600 mg/dl) for an extended time. The interesting characteristics is there are no elevation of ketones in this situation. The condition leads to serious dehydration, excessive thirst, and confusion. It is often caused or triggered by a recent infection or sickness.

  5. Kussmaul respirations
    • Rationale:

      This answer is not correct because the client with HHS does not have ketones in the blood so Kussmaul breathing would not occur. The interesting characteristics of HHS is there are no elevation of ketones in this situation. Often HHS is also called “non-ketoticâ€ which is unlike DKA which has elevated ketones as a classic symptom. HHS occurs when a client has extremely high blood glucoses (> 600 mg/dl) for an extended time. The condition leads to serious dehydration, excessive thirst, and confusion. It is often caused or triggered by a recent infection or sickness.

  6. Blood glucose >600 mg/dL
    • Rationale:

      This answer is correct because extreme hyperglycemia (>600 mg/dL) is associated with HHS. Hyperglycemic hyperosmolar syndrome (HHS) is a serious complication of type 2 diabetes mellitus. It occurs when a client has extremely high blood glucoses (> 600 mg/dl) for an extended time. The interesting characteristics is there are no elevation of ketones in this situation. The condition leads to serious dehydration, excessive thirst, and confusion. It is often caused or triggered by a recent infection or sickness.

Overview

Symptoms associated with HHS are confusion, extreme dehydration, blood glucose of >600 mg/dL. Abdominal pain and Kussmaul respirations are associated with DKA but not HHS.

Explanation

Learning Outcomes

Hyperglycemic hyperosmolar syndrome (HHS) is a serious complication of type 2 diabetes mellitus. It occurs when a client has extremely high blood glucoses (> 600 mg/dl) for an extended time. The interesting characteristics is there are no elevation of ketones in this situation. The condition leads to serious dehydration, excessive thirst, and confusion. It is often caused or triggered by a recent infection of sickness. Treatment (unless airway or breathing is involved) begins with fluid replacement to address the circulation concerns, then insulin therapy to address the elevated blood glucose.

Test Taking Tip

HHS is often called HHNS, which stands for hyperglycemic hyperosmolar nonketotic syndrome. Let the name help you know what happens in this condition. Hyperglycemia (>600 mg/dL), hyperosmolar (extreme dehydration), and nonketotic (no acidosis, no ketones, no fruity breath, no Kussmaul breathing). It also happens to DM 2 clients and has a slow onset, which is very different from DKA.

Video Rationale