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Hyperosmolar Hyperglycemic Non-Ketoacidosis (HHNK)

Hyperosmolar hyperglycemic non-ketoacidosis (HHNK) is considered a life-threatening emergency, and has known mortality rates as high as 5-20%.  HHNK is commonly seen in persons with type 2 diabetes who are experiencing an illness (fever or urinary tract infection are common) that somehow leads to a decreased fluid intake. This can be either a decreased perception of thirst as sometimes seen in an older population, or a reduced ability to drink fluids, such as nausea and vomiting.  As noted in a website article on HHNK, “… the elderly, the chronically ill, and institutionalized populations are at increased risk for HHNK. Any living situation or comorbidity that prevent adequate hydration, including for example immobility, advanced age, debility, dementia, agitation, impaired thirst response, restricted access to water, and restraint use, place these patients at risk.” https://emedicine.medscape.com/article/1914705-overview#a5

HHNK is characterized by dehydration, and glucose levels as high as 600mg/dl or higher. Patients often experience some alteration in their level of consciousness (up to and including a comatose state). Unlike a person with type 1 diabetes, who may develop diabetic ketoacidosis when ill, most patients with HHNK do not develop significant ketoacidosis. Insulin remains available in small amounts, but insufficient to prevent hyperglycemia. Due to the high levels of glucose in the bloodstream, diuresis and dehydration occurs. HHNK patients have been known to lose large amounts of water volume. There have been reports of patients with HHNK having up to 9L of water deficit because of this diuresis. In addition, patients with HHNK have been observed with other symptoms such as high fevers, extremely dry mouth, increased thirst, weakness, confusion, dizziness and hallucinations.

As noted, this is a true medical emergency situation and persons with suspected HHNK need to be brought to the nearest Emergency Department. Initial care involves rehydration with intravenous fluids, electrolyte replacement therapy, treatment of any underlying infections, proper airway management, and extensive patient /provider education to reduce the risk of reoccurrence. Education would include strict monitoring of blood glucose levels and sick day management. Left untreated, HHNK can quickly progress to severe dehydration, coma and death.

For further information/education on HHNK, check out these website links.

Guest post by Maureen Sullivan-Tevault and  originally appeared at MaureenSullivanRN.com.

Maureen has over 25 years in Emergency and Trauma nursing, including nursing positions as the Emergency Department Manager, Director of Staff Education, Trauma Coordinator, and Stroke Program Manager. In addition, she has also been certified as both a BLS and ACLS instructor, and adjunct faculty for an LPN nursing program. Maureen has also written nursing articles for the following journals: Nursing Spectrum, ADVANCE nursing magazine, and The Journal of Emergency Care, Rescue, and Transportation.  Her expertise is in diabetes education, stroke education and prevention, and all aspects of emergency medicine.

Maureen has written multiple continuing education courses on diabetes, stroke, human trafficking, norovirus and other healthcare topics:

Diabetes: An Introduction
Diabetes Management and Insulin Pumps
Diabetes Management and Insulin Pumps for School Nurses
Diabetes: An Introduction for Administrators
Human Trafficking
Management of Norovirus Gastroenteritis in Healthcare Settings
Mangement of Norovirus Gastroenteritits in Post Acute Care Settings
OSHA Hazard Communication
Stroke Management: Advance
Stroke: An Introduction
Stroke: An Introduction for Administrators

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Posted: 11/14/2018 10:33:29 AM
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