Lecture Notes: Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNS)

Introduction

• Topic Discussed: Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNS)
• Relation to Diabetes: Life-threatening complication of diabetes mellitus similar to Diabetic Ketoacidosis (DKA)

Overview

• HHNS Characteristics:
  • Extreme hyperglycemia (blood sugar > 600 mg/dL, possibly into 4 digits)
  • Hyperosmolarity
  • No significant fat breakdown (no ketones)
  • Main symptoms: Hyperglycemia and dehydration

Pathophysiology

• Glucose:
  • Energy source for cells
  • In HHNS, body is resistant to insulin, leading to excess glucose in the bloodstream
• Insulin:
  • Helps glucose enter cells
  • In HHNS, insufficient insulin prevents glucose uptake but prevents fat breakdown
• Kidneys:
  • Cannot reabsorb excessive glucose, leading to osmotic diuresis
  • Results in polyuria and electrolyte excretion (sodium, potassium, chloride)

Symptoms

• Key Symptoms:
  • Heavy-duty hyperglycemia (extremely high blood sugar)
  • Dehydration due to osmotic diuresis
  • Polyuria and polydipsia
  • Dry mucous membranes, fever, fatigue
  • Mental status changes (confusion, potential for coma and seizures)
• Distinguishing from DKA:
  • No ketosis or acidosis in HHNS due to enough insulin present
  • More common in Type 2 diabetics, rare in Type 1

Causes

• Primary Causes:
  • Illness or infection, especially in older adults
  • Gradual onset compared to sudden onset of DKA

Nursing Interventions

• Goals:
  • Hydration and blood sugar reduction
• IV Fluids:
  • Start with isotonic solutions (0.9% saline)
  • Progress to hypotonic solutions (0.45% saline) as required
  • Add dextrose when blood sugar is between 250-300 mg/dL to prevent rapid drop
• Insulin Therapy:
  • Only regular insulin can be given IV
  • Start with a bolus, followed by an insulin drip
  • Monitor potassium levels to avoid hypokalemia
  • Regular glucose checks to adjust insulin dosage
• Potassium Solution:
  • Help maintain normal potassium levels due to insulin moving potassium into cells
  • Watch out for phlebitis, EKG changes, and renal function

Conclusion

• Follow-Up:
  • Take quizzes to assess understanding
  • Compare HHNS and DKA in further study for NCLEX and nursing exams

Additional Resources

• Website: Free quiz on HHNS available
• Next Video: Comparison between DKA and HHNS
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