hyperglycemic hyperosmolar state

WordNet

1. express in words; "He said that he wanted to marry her"; "tell me what is bothering you"; "state your opinion"; "state your name" (同)say, tell
2. a state of depression or agitation; "he was in such a state you just couldnt reason with him"
3. the way something is with respect to its main attributes; "the current state of knowledge"; "his state of health"; "in a weak financial state"
4. a politically organized body of people under a single government; "the state has elected a new president"; "African nations"; "students who had come to the nations capitol"; "the countrys largest manufacturer"; "an industrialized land" (同)nation, country, land, commonwealth, res publica, body_politic
5. the territory occupied by one of the constituent administrative districts of a nation; "his state is in the deep south" (同)province
6. the group of people comprising the government of a sovereign state; "the state has lowered its income tax"

PrepTutorEJDIC

1. 〈C〉(人・物事の)『状態』,ありさま,様子 / 〈C〉《a ~》《話》極度の緊張状態,異常な精神状態 / 〈U〉地位,階級,身分 / 〈C〉〈U〉《しばしばS-》『国家』,国,政府 / 〈C〉《時にS-》(アメリカ・オーストラリアなどの)『州』 / 《the States》《話》『米国』 / 〈U〉威厳;公式;堂々とした様子 / 国家の,国事に関する / 《しばしばS-》《米》州の,州立の / 公式の,儀式用の
2. …‘を'『はっきり述べる』,公式に申し立てる / 〈当局が〉…‘を'指定する,決める
3. 決まった,規定の;定期の / はっきり述べられた,明言された;公認された

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/03/13 00:11:19」(JST)

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[Wiki en表示]

Hyperosmolar hyperglycemic state
Classification and external resources
ICD-10	E10-E14
ICD-9-CM	250.2
DiseasesDB	29213
eMedicine	emerg/264
MeSH	D006944

Hyperosmolar hyperglycemic state (HHS) is a complication of diabetes mellitus (predominantly type 2) in which high blood sugars cause severe dehydration, increases in osmolarity (relative concentration of solute) and a high risk of complications, coma and death. It is diagnosed with blood tests. It is related to diabetic ketoacidosis (DKA), another complication of diabetes more often (but not exclusively) encountered in people with type 1 diabetes; they are differentiated with measurement of ketone bodies, organic molecules that are the underlying driver for DKA but are usually not detectable in HHS.

The treatment of HHS consists of correction of the dehydration with intravenous fluids, reduction of the blood sugar levels with insulin, and management of any underlying conditions that might have precipitated the illness, such as an acute infection.

Older names for HHS are hyperosmolar non-ketotic coma (HONK), nonketotic hyperosmolar coma, hyperosmolar hyperglycemic nonketotic syndrome (HHNS, favoured by the American Diabetes Association).

Signs and symptoms

According to the consensus statement published by the American Diabetes Association, diagnostic features of HHS may include the following:

• Plasma glucose level >600 mg/dL (>30 mmol/L)
• Serum osmolality >320 mOsm/kg
• Profound dehydration, up to an average of 9L (and therefore substantial thirst (polydipsia))
• Serum pH >7.30
• Bicarbonate >15 mEq/L
• Small ketonuria (~+ on dipstick) and absent-to-low ketonemia (<3 mmol/L)
• Some alteration in consciousness

Additionally it may also lead to:

• Neurologic signs including focal signs such as sensory or motor impairments or focal seizures or motor abnormalities, including flaccidity, depressed reflexes, tremors or fasciculations.
• Hyperviscosity and increased risk of blood clot formation

Diagnosis

The major differential diagnosis is diabetic ketoacidosis (DKA). In contrast to DKA, serum glucose levels in HHS are extremely high, usually greater than 40-50 mmol/L, but an anion-gap metabolic acidosis is absent or mild. Altered mental status is also more common in HHS than DKA. Although traditionally DKA has been associated with Type I Diabetes, whereas HHS has been associated with Type II, HHS can be seen in patients of both types. HHS also tends to have an elderly preponderance.

Cranial imaging is not used for diagnosis of this condition. However, if MRI is performed, it may show cortical restricted diffusion with unusual characteristics of reversible T2 hypointensity in the subcortical white matter.

Pathophysiology

Nonketotic coma is usually precipitated by an infection, myocardial infarction, stroke or another acute illness. A relative insulin deficiency leads to a serum glucose that is usually higher than 33 mmol/l (600 mg/dl), and a resulting serum osmolarity that is greater than 320 mOsm. This leads to excessive urination (more specifically an osmotic diuresis), which, in turn, leads to volume depletion and hemoconcentration that causes a further increase in blood glucose level. Ketosis is absent because the presence of some insulin inhibits hormone-sensitive lipase mediated fat tissue breakdown.

Management

Intravenous fluids

Treatment of HHS begins with reestablishing tissue perfusion using intravenous fluids. People with HHS can be dehydrated by 8 to 12  liters. Attempts to correct this usually take place over 24 hours with initial rates of normal saline often in the range of 1 L/h for the first few hours.

Electrolyte replacement

Severe potassium deficits often occur in HHS. They usually range around 350 mEq in a 70 kg person. This is generally replaced at a rate 10 mEq per hour as long as there is urinary output.

Insulin

Insulin is given to reduce blood glucose concentration; however, as it also causes the movement of potassium into cells, serum potassium levels must be sufficiently high or dangerously low blood potassium levels may result. Once potassium levels have been verified to be greater than 3.3 mEq/l, then an insulin infusion of 0.1 units/kg is begun.

References

UpToDate Contents

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• 1. 成人における糖尿病性ケトアシドーシスおよび高浸透圧性高血糖状態の治療 treatment of diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults
• 2. 成人における糖尿病性ケトアシドーシスおよび高浸透圧性高血糖状態の臨床的特徴および
  診断 clinical features and diagnosis of diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults
• 3. 糖尿病性ケトアシドーシスおよび高浸透圧性高血糖状態の疫学および病因 epidemiology and pathogenesis of diabetic ketoacidosis and hyperosmolar hyperglycemic state
• 4. 横紋筋融解症の原因 causes of rhabdomyolysis
• 5. 小児および思春期における2型糖尿病の疫学、症状、および診断 epidemiology presentation and diagnosis of type 2 diabetes mellitus in children and adolescents

English Journal

• Predictors of Recurrent Hospital Admission for Patients Presenting With Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.

• Bradford AL1, Crider CC2, Xu X3, Naqvi SH3.
• Journal of clinical medicine research.J Clin Med Res.2017 Jan;9(1):35-39. Epub 2016 Nov 24.
• BACKGROUND: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are two serious, preventable complications of diabetes mellitus. Analysis of variables associated with recurrent DKA and HHS admission has the potential to improve patient outcomes by identifying possible areas for in
• PMID 27924173

• Secular Trends in Admissions and Mortality Rates from Diabetes Mellitus in the Central Belt of Ghana: A 31-Year Review.

• Sarfo-Kantanka O1, Sarfo FS1,2, Oparebea Ansah E1, Eghan B1,2, Ayisi-Boateng NK3, Acheamfour-Akowuah E1.
• PloS one.PLoS One.2016 Nov 22;11(11):e0165905. doi: 10.1371/journal.pone.0165905. eCollection 2016.
• INTRODUCTION: Diabetes Mellitus is currently a leading cause of morbidity and mortality throughout the world, particularly in sub-Saharan Africa where a significant proportion of diabetes cases are now found. Longitudinal profiling of in-patient admissions and mortality trends from diabetes provide
• PMID 27875539

• Reversible splenial lesion syndrome with a hyperosmolar hyperglycemic state and neuroleptic malignant syndrome caused by olanzapine.

• Kaino K1, Kumagai R1, Furukawa S1, Isono M1, Muramatsu A1, Fujii M1, Muta Y1, Asada T1, Fujihara K1, Yagyu H1.
• Journal of diabetes investigation.J Diabetes Investig.2016 Nov 18. doi: 10.1111/jdi.12597. [Epub ahead of print]
• A 27-year-old woman with panic disorder taking 20 mg olanzapine daily for 4 months was admitted to Mito Kyodo General Hospital, Mito, Ibaraki, Japan, because of disturbed consciousness with fever, hyperglycemia, hyperosmolarity and elevated creatine phosphokinase. She was diagnosed with a hyperosm
• PMID 27863115

Japanese Journal

• Step Beyond Resident(第98回)甘いものはお好き?(Part 3)DKA(Diabetic KetoAcidosis)とHHS(Hyperglycemic Hyperosmolar State)

• 林 寛之
• レジデントノ-ト 12(8), 1437-1447, 2010-09
• NAID 40017261778

• 糖尿病の治療の原則と実際:高血糖・低血頭への緊急対応 (糖尿病のリハビリテーション実践マニュアル)

• 宮崎 博子
• Monthly book medical rehabilitation (117), 59-70, 2010-04
• NAID 40017104869

Related Links

• Hyperosmolar Hyperglycemic State

Hyperosmolar hyperglycemic state is a life-threatening emergency manifested by marked elevation of blood glucose, hyperosmolarity, and little or no ketosis. With the dramatic increase in the prevalence of type 2 diabetes and the aging population, this condition may be encountered more ...

• Hyperosmolar Hyperglycemic State

Hyperosmolar hyperglycemic state (HHS) is 1 of 2 serious metabolic derangements that occurs in patients with diabetes mellitus (DM) and can be a life-threatening emergency. It is less common than the other acute complication of diabetes, diabetic ketoacidosis (DKA). HHS was previously termed ...

Related Pictures

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★リンクテーブル★

リンク元	「高浸透圧性非ケトン性昏睡」
関連記事	「state」「hyperosmolar」

「高浸透圧性非ケトン性昏睡」

　　[★]

英

nonketotic hyperosmolar coma (HIM) non-ketotic hyperosmolar coma, hyperosmolar non-ketotic coma(DMR) HONK hyperosmolar nonketotic coma

同

高血糖高浸透圧昏睡、糖尿病性高血糖性高浸透圧性昏睡 hyperglycemic hyperosmolar nonketotic coma hyperglycemic hyperosmolar non-ketotic coma(DMR) HHNC、高浸透圧性非ケトン性糖尿病昏睡 hyperosmolar non-ketotic diabetic coma hyperosmolar nonketotic diabetic coma HONK、非ケトン性高血糖性昏睡 nonketotic hyperglycemic coma、非ケトン性高浸透圧性昏睡

hyperglycemic hyperosmolar state？ HHS？ (HIM)

関

糖尿病

[show details]

高浸透圧性非ケトン性昏睡 : 約 35,000 件
非ケトン性高浸透圧性昏睡 : 約 9,010 件

概念

• 2型糖尿病が基礎にある。
• 50歳以上に好発し、インスリン非依存性糖尿病患者が腎不全や中枢神経障害、悪性腫瘍、消化器疾患、呼吸器感染などを合併するときに多くみられ、ステロイドや利尿薬の投与、輸液や高カロリー補給、人工透析などの際に医原性に起きやすい。

鑑別

• 糖尿病性ケトアシドーシス

• 呼吸(Kussmaul呼吸があるわけではない。代謝性アシドーシスの呼吸性代償が必要ないことが多い？)
• 尿中ケトン体、動脈血HCO3-

国試

• 105A021

「state」

　　[★]

• n.

• 状態、状況、州

• v.

• 述べる、言う

関

aspect、circumstance、circumstantial、condition、context、describe、mention、note、position、province、say、situation、situational、speak、status、tell

　 　 　 　 　 　 　 　

「hyperosmolar」

　　[★]

• adj.

• 高浸透圧性の、高浸透圧の

関

hyperosmolality、hyperosmolarity、hyperosmosis、hyperosmotic、hypertonic、hypertonicity