HYPEROSMOLAR

HYPERGLYCEMIC
SYNDROME (HHNS)
-Is a serious condition caused by
extremely high blood sugar
levels. The condition most
commonly occurs in people with
type 2 diabetes. It’s often
triggered by illness or infection.
Predisposing Factors

• Have type 2 diabetes

• Are older than age 65
• Have another chronic health
condition
• Have an infection
• Take certain medications
Clinical Manifestation

• High blood sugar greater than

600mg/d or 33.3 mmol/L
• Excessive thirst
• Dry mouth
• Increased Urination
• Warm, dry skin
• Fever
• Drowsiness
• Vision loss
Anatomy and Physiology
 Liver
The liver’s major functions are in the
metabolic processes of the body. These
include:
breaking down or converting substances
extracting energy
making toxins less harmful to the body and
removing them from the bloodstream
Anatomy and Physiology
Pancreas
-a wedge-shaped elongated gland which lies in
the abdominal cavity.

Three regions: the head, which lies over the vena

cava in the C-shaped curve of the duodenum; the
body, which lies behind the duodenum; and the
tail, which is situated under the spleen.

The pancreas is composed of two types of cell,

exocrine and endocrine cells.
Anatomy and Physiology
 Exocrine Function
Pyramidal acinar cells are exocrine cells
that compose the bulk of pancreatic tissue.
Groups of acinar cells form an acinus, and
groups of acini form grapelike lobules. The
acini secrete the digestive enzymes of the
pancreatic juice.
 Pancreatic enzymes
Anatomy and Physiology
 There are three main types of enzyme
present in pancreatic juice:
 Amylases, which break down
carbohydrates into glucose and maltose.
 Lipases, which are important in the
early stages of fat breakdown.
 Proteases, including trypsinogen, the
precursor of proteolytic trypsin.
Anatomy and Physiology
Endocrine Function
 Endocrine cells, or the islets of Langerhan, make
up 1% of the pancreatic cells. The major endocrine
cells of the pancreas are alpha, beta and delta cells,
which secrete glucagons, insulin and somatostatin,
respectively.
 When the blood sugar level falls below normal levels,
the alpha cells are stimulated to secrete glucagon,
which accelerates the conversion of glycogen to
glucose in the liver. When the blood sugar level is
above normal, the beta cells secrete insulin, which
promotes both the metabolism of glucose by tissue
cells and the conversion of glucose to glycogen, which
is then stored in the liver.
Anatomy and Physiology
 Insulin
 Beta cells have channels in their plasma
membrane that serve as glucose
detectors.
PATHOPHYSIOLOGY OF HHNK
Non-modifiable Risk Factors Modifiable Risk factors

*Age *Overweight/ Obesity

*Race/Ethnic background *Physical inactivity
*Family history *High blood pressure
*History of gestational diabetes *Abnormal cholesterol lipid levels

Decreased Insulin Action

Relative

Peripheral tissue
PATHOPHYSIOLOGY OF HHNK
Amino acids

Liver

Glycogenolysis
&gluconeogenesis
PATHOPHYSIOLOGY OF HHNK
Hyperglycemia

Osmotic diuresis

Dehydration

Hyperosmolar Hyperosmolar
Nonketotic Syndrome/ HHNK
Diagnostic Procedure
 The emergency medical team will do a
physical and mental status exam and
may ask those who are with you about
your medical history.
 blood and urine test
 Intravenous fluids
 Intravenous insulin
 Intravenous potassium
 HHNS Normal

Plasma glucose >30 mmol/L 3.9-6.1 mmol/L (70-

level (>600 mg/dL) 110 mg/dL)
Serum osmolality >320 mOsm/kg 285-295 mOsm/kg

Serum pH 7.30 7.35–7.45

Bicarbonate >15 mEq/L 23-29 mEq/L

BUN > 30 md/dL 7 - 20 md/dL

(increased)
Creatinine > 1.5 mg/dL 0.6-1.2 mg/dL
(increased)
The main goals in the treatment of
hyperglycemic hyperosmolar syndrome
(HHNS)
 Are as follows:
 To vigorously rehydrate the patient while
maintaining electrolyte hemoestasis
 To correct hyperglycemia
 To treat undelying disease
 To monitor and assist cardiovascular,
pulmonary, renal and central nervous
system (CNS) function.
 -depends on the cause and how well you
respond to treatment.
The goal of treatment is to return your
blood sugar to a normal level and keep it
in a normal range.
 Treatment may include:
 You will have a small tube (IV catheter)
inserted into a vein in your hand or arm.
 This will allow for medicine to be given
directly into your blood and to give you
fluids, if needed.
 Your provider may prescribe medicines to:
Keep your blood sugar controlled Treat
other medical problems that may have
been caused by or made worse because of
diabetes
 Treat pain Treat or prevent an infection
Prevent blood clots Prevent side effects,
such as nausea or constipation, from other
treatments
 Replace vitamins and minerals You may
receive oxygen through a small tube
placed under your nose or through a mask
placed over your face.
 If you develop blood clots, you may need
surgery to remove them. You may need
kidney dialysis to help filter your blood if
your kidneys are not working properly.