In this episode, I’ll discuss the difference between DKA and HHS.
Definition
Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the most serious acute complications of diabetes. These diabetic crises cause thousands of deaths annually in the US.
DKA and HHS differ clinically according to the presence of ketoacidosis and the degree of hyperglycemia.
In DKA metabolic acidosis is often the major finding. The serum glucose is below 800 mg/dL and usually in the 350-500 mg/dL range. DKA usually evolves rapidly.
In HHS, there is little or no ketoacidosis and the serum glucose concentration frequently exceeds 1000 mg/dL. HHS usually evolves over a period of several days.
Overlap between DKA and HHS occurs in more than one-third of patients.
Pathogenesis
Insulin deficiency/resistance and glucagon excess are responsible for the development of DKA and HHS.
The deficiency in insulin (either absolute or relative deficiency) is more severe in DKA compared with HHS.
In HHS the residual insulin secretion and its systemic activity minimizes the development of ketoacidosis but it is not adequate to control hyperglycemia.
In patients with absolute or relative insulin deficiency, DKA and HHS are usually precipitated by a stressor such as infection or discontinuation of / inadequate insulin therapy.
Members of my Hospital Pharmacy Academy have access to an in-depth training on DKA and HHS treatment in the ICU from a pharmacist’s point of view. To access this and many more resources to help you in your practice go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
Leave a Reply