Question

Compare and contrast the clinical manifestations, underlying pathophysiology, and management of DKA and HHNS.

Answer 1

DKA(Diabetic Ketoacidosis is a life threatening condition in which the acid level go up to in blood called ketones because of blood sugar is too high for too long..This condition can be treatable and preventable too.
HHNS( Hyperosmolar hyperglycemic nonketotic syndrome) is a life threatening condition more than DKA..It can lead to death or coma if not treated for the correct timing..It is a complication of type 2 diabetes..Inthis high blood sugar level there wont be any ketones present..
Clinical manifestation of DKA is:
   -High blood sugar <240mg/dl
   -Dry mouth
   -feeling thirsty
   -deep and rapid breathing
    -flushed face
    -Head ache
   -Muscle pain
   -Nausea and vomiting
   -stomach pain
      -fruity smell on breath..
Clinical manifestation of HHNS is:
      -Blood sugar more than 600mg/dl
      -Dry mouth,excess urination
      -extreme thirst
      -warm,dry skin
      -High fever
      -Insomnia
      -loss of vision
      -Hallucination
      -weakness on oneside of the body.
comaparing to DKA HHNS has more clinical manifestation and it should be treated with more diagnosis..
Pathophysiology of DKA:
      -Ketones production too quickly and buildup in the blood and urine..it make the blood acidic(Toxic)
   -Patient with Type 1 diabetes can have diabetic ketoacidosis
   -Patient with infection,injury,surgery, especially missing dose of insulin can go for DKA..
   -electrolyte imbalance also underlying cause of DKA..
Pathophysiology of HHNS:
      -same like DKA in this case type 1 diabetis and type 2 diabetis can have HHNS
   -Patient with illness and infection can have this HHNS
   -Due to high blood sugar level there will high osmolarity without significant ketoacidosis
      -Here also due to electrolyte imbalance can cause this HHNS..
Management of DKA:
    -Do physical exam and collect history..and check the previous insulin doses and duration
    -the goal of treatment is reduce the high blood sugar level by insulin administration..If sugar level more than 300mg/dl dextrose iv fluids infusion must be started
    -Next we have to replace the fluid loss in case of vomiting so IV infusion must be started..
   -check urine ketones every 30minutes..
   -check the blood sugar level every 1 hour
   -check ABG level and serum potassium level because of electrolyte imbalance
Management of HHNS:
   -collect the previous medical history and treatment
      -Start immediately intravenous fluids to reestablish the tissue perfusion..
      -To correct metabolic level potassium replacement is required..once level come <3.3 mEq/dl stop the infusion
   -Monitor unine out put level every 1 hour..
      -start IV insulin infusion 0.1units/kg/hr
   -check potassium,BUN and serum electrolyte level every 6 hours
   -Check blood glucose level every 1 hour
      -Patient with hyperosmolar hyperglycemic syndrome prone for catabolic malnourishment..so administer b-complex vitamin supplement
   -Proper health education needed forDKA and HHNS to early prevention and dectection of diabetis-related problems..