Comparison
of DKA vs. HHNS
|
HHNS |
DKA |
|
|
Epidemiology |
17.5 cases per 100,000
person-years; 1 in 1000 diabetic hospital admissions. Mortality as high as
12% to 46%. Increasing age and higher Sosm portend
increased mortality. |
4.6 – 8 per 1000 diabetic
patients; 2% to 8% of all diabetic hospital admissions. Mortality 1-2%
(usually NOT from DKA itself but rather the precipitant, e.g., MI, sepsis,
pancreatitis) OR complications of treatment. |
|
Presentation |
poor glycemic
control, polyuria, polydipsia,
lethargy, AMS (mild confusion to lethargy), seizures, coma |
vomiting, thirst, polyuria, altered, weakness, fatigue, abdominal pain |
|
Onset |
Insidious (days to weeks) |
Short (hours to days) |
|
Precipitants |
new diabetes OR existing diabetes AND: med
noncompliance, acute illness (infection, MI, pancreatitis, CVA, burns, GI
bleed, PE, trauma, renal failure), meds (thiazides,
beta-blockers, phenytoin, steroids, cisplatinum), substance abuse (EtOH,
cocaine). Precipitant not always clear but try to identify one whenever
possible. |
|
|
Blood Glucose |
> 600 |
> 250 |
|
Arterial pH |
> 7.3 |
< 7.3 |
|
Serum bicarbonate |
> 20 |
< 15 |
|
BUN |
>30 |
<25 |
|
Osmolality |
>330 |
<320 |
|
TBW
Deficit |
8-10 L |
5-7 L |