hey everyone it's sarth register nurse rn.com and in this video I'm going to be going over dka versus hhns these are two complications of diabetes malius and what I want to do for you is simplify those subtle um signs and symptoms and those differences so you can get them right on your exam now this video is part of a indocin series and in the previous video I covered in depth dka where I covered the patho the nursing intervention the pharmacological aspects and in the other video I covered hhns in the same way so if you want to access those videos you can access the card above and it'll take you to a playlist and you can get to those videos now after this video be sure to go to my website register nurse rn.com and take the free quiz that's going to quiz you on the differences between dka and hhns so let's get started behind me I have this table and in the table I have put the differences between the two so you can easily see it so what we're going to do is we're going to go through dka and then we'll go through hhns and compare the two okay diabetic keto acidosis and hhns hhns stands for hypoglycemic hyperosmolar non-ketotic syndrome let the names help you because they explain a lot of the differences between these two issues okay dka diabetic keto acidosis this is mainly seen in your type one diabetics it can be seen in type two but it's type one so remember that hhns is mainly seen in type two diabetics ketones and acidosis is present in this this is because you have the breakdowns of fat because this patient has absolutely no insulin in the body so the body needs fuel so it breaks down those fats hence keto acidosis however hhns there is absolutely no breakdown of ketones or acidosis so you're not going to see any ketones in the urine and the patients's not going to have metabolic acidosis because there is just enough insulin in the body to prevent the body from breaking it down and breaking down fats and usually these cells are just not receptive to insulin but there is some insulin that's why most of your type two diabetics this is scena in dka you have hypoglycemia you're going to have hypoglycemia in both of them but with dka it's just going to be greater than 300 Mig per deciliter it's going to be elevated but with hhns you are going to have heavy duty hypoglycemia remember the little pneumonic the two h's and hhns HH heavy duty hypoglycemia these sugars are going to run greater than 600 you can see them not even registering on a monitor you may have have to get an IV draw or um they will be four digigit these glucoses are super high in these patient patent um ver in dka the osal osmolarity is variable it's not much as of an issue as it is in hhns you're going to have really high osmolarity and this is due to because the blood is super concentrated with those crazy glucose levels so you're going to see a lot more problems due to the osmolarity in this condition like dehydration than you will see in dka dka happens suddenly fast it comes on a H hns it's going to happen gradually over time dka the causes you have no insulin present so that's one cause um maybe they haven't been taking their insulin injections at all um illness infection they needed more insulin because they're not taking it as much because their body stressed out but they needed more but they didn't know that they've been skipping meals again because they don't feel good or they are they don't know that they're diabetic this is usually one of the first signs in New diagnosed diabetics is dka causes of this the cells again are just not receptive to insulin there's just not enough present but there's just enough present to prevent ketosis the main cause of hhns is usually because that diabetic patient has a severe infection or illness this is mainly seen in your young and newly diagnosed patients compared to hhns this is going to be seen in your mainly your your older adults who are presenting with a severe infection main problems include hypoglycemia you're going to see that ketosis and acidosis where the blood pH will be 7.5 or less and the by carb will be less than 15 however in hhns you are just going to have that extreme hyperglycemia and dehydration severe dehydration due to that hyperosmolarity concentrated glucose in the blood treatments are the same for these um which will include IV fluids insulin electrolyte replacement most um more likely the potassium replacement however with hhns one of the best treatments is just getting them rehydrated because those cells are literally shriveled up gone wa not gone but they're wasted and rehydrating them is actually going to move um your electrolytes back it's going to decrease that blood sugar just as well as the insulin so IV fluids is super important in our patients with hhns dka one of the typical signs because both both of these conditions you're going to have polyurea you're going to have polydipsia but the big differences in signs and symptoms is that these patients in dka can have the cosmal breathing and this is due to the metabolic acidosis where the body is trying to blow off that extra acid the carbon dioxide to try to compensate for these acidotic conditions so it's rapid deep breathing and they will have the acetone breath and abdominal pain and this is due to the ketones breaking down however remember in hhns you don't have the ketosis or acidosis so you won't have cosmal breathing or the fruity breath but you're more likely to see mental status changes in these patients due to that severe dehydration that they're experiencing so that is the difference between dka and hhns now go take that quiz on my website register nurs rn.com and see how well you grasp this material and thank you so much for watching and please consider subscribing to this YouTube channel