1. What is diabetic ketoacidosis (KDA)? Hyperosmotic Hyperglycemic state (HHS)?

Diabetic ketoacidosis is an extreme metabolic Hyperosmotiic Hyperglycemic State is a life-

state due to elevated serum ketones that
resulted from insulin deficiency from a new-onset
diabetes, prescription or illicit drug use, insulin
non-compliance and increased need for insulin
due to infection.
Due to the breakdown of fatty acids (lipolysis),
ketone body is produced (ketogenesis) which are
acidic. Acidosis happens when the levels of
ketones exceed’s the buffering capacity of the
body.
2. What are the differences of DKA and HHS?
threatening endocrine emergency manifested by
hyperosmolarity and increased level of blood glucose
with little or no ketosis.
HHS is initiated by the elevated levels of
counterregulatory hormones which stimulates the
production of hepatic glucose thorugh gluconeogenesis
and glycogenolysis that leads to intracellular water
depletion, osmotic dieresis and hyperglycemia.
Patients with type 2 diabetes meliitus are commonly
affected.

DKA HHS
Causes Non adherence Non adherence
Underlying infections Undiagnosed diabetes
Substance abuse mellitus
Substance abuse
Coexisting disease
Clinical Presentation Most common: Polyuria with Profound dehydration
polydipsia Stupor, coma
Other common: Fatigue, Sunken eyeballs
dyspnea, weight loss, Cool Extremities
vomiting, febrile illness,
polyphagia, abdominal pain
Diagnosis Presence of hyperglycemia, Blood sugar – greater than
ketosis and acidosis 600 mg/dL
Serum glucose level – greater pH level greater than 7.30
than 250mg/dL There is trace or absence of
pH less than 7.3 ketosis
serum bicarbonate level –less Creatinine, BUN and Hc levels
than 18 mmol per L are always elevated
Management/Treatment  Fluid Replacement  Vigorous IV
(0.9% saline is usually rehydration
used)- for dehydration  Electrolyte
 Insulin + IV fluids – management
further correct  IV insulin
hyperglycemia  Diagnosis and
 SC insulin can be used management of
for uncomplicated coexisting
 DKA problems/disease
 Potassium
replacement
 Bicarbonate therapy
 Monitor glucose and
electrolytes level

Reference:
Stoner, G.D (2017) Hyperosmolar Hyperglycemic State, American Family Physician: Peoria,
Illinois
Westerberg, D.P (2013) Diabetic Ketoacidosis: Evaluation and Treatment. Camden, New Jersey