DKA vs HHS | Endocrine System (Part 4)

Summary

In this educational video, Eddie Watson from ICU Advantage explains the differences between Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS), focusing on their causes, symptoms, and treatments. DKA is common in type 1 diabetics, characterized by high glucose levels, low bicarbonate, and metabolic acidosis. HHS typically affects type 2 diabetics, presenting with severe dehydration without ketosis. The video outlines the pathophysiology behind these conditions and emphasizes the importance of fluid and electrolyte management, insulin therapy, and treating underlying causes for effective patient care.

Takeaways

• 🚑 DKA (Diabetic Ketoacidosis) and HHS (Hyperosmolar Hyperglycemic State) are both hyperglycemic emergencies requiring urgent intervention.
• 🏥 DKA is more common in type 1 diabetics, whereas HHS is typically seen in type 2 diabetics.
• 📈 DKA is characterized by high blood glucose, low bicarbonate levels, and a pH less than 7.3, indicating anion gap metabolic acidosis.
• 🔍 Causes of DKA include new-onset type 1 diabetes, insufficient insulin, stress, infection, trauma, surgery, and alcohol intoxication.
• 🧬 The pathophysiology of DKA involves insulin deficiency leading to increased fatty acid metabolism, ketone production, and fluid loss.
• 🌡 Signs of DKA include fruity breath due to acetone, Kussmaul respirations, abdominal pain, and neurological symptoms like paresthesia and aphasia.
• 💧 HHS is defined by extreme hyperglycemia without ketosis, leading to severe dehydration and high osmolarity.
• 🏋️‍♂️ The onset of HHS is often slow and progressive, potentially developing over weeks to months.
• 🩺 Treatment for both DKA and HHS involves fluid replacement, insulin therapy for hyperglycemia, electrolyte replacement, and treating the underlying cause.
• ⏱ Monitoring is crucial during treatment to prevent complications like cerebral edema and hypokalemia.

Q & A

What are the two hyperglycemic emergencies discussed in the lesson?

The two hyperglycemic emergencies discussed are Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS).

Who is more likely to experience DKA, type 1 or type 2 diabetics?

DKA is almost primarily experienced by type 1 diabetics, although it can rarely occur in type 2 diabetics.

What are the defining characteristics of DKA?

The defining characteristics of DKA include hyperglycemia, hypovolemia, ketone emia, anion gap metabolic acidosis, a glucose level greater than 300 milligrams per deciliter, a bicarbonate level less than 15 mEq/L, a pH less than 7.3, and the presence of ketones in the blood and urine.

What are some common causes of DKA?

Common causes of DKA include newly diagnosed type 1 diabetes, insufficient insulin administration, stressful events, infections, trauma, surgery, pregnancy, and alcohol intoxication.

How quickly can DKA develop?

DKA can develop in less than 24 hours, oftentimes developing very quickly in patients.

What is the primary difference between DKA and HHS?

The primary difference is that DKA involves the presence of ketosis, whereas HHS is characterized by hyperglycemia with profound dehydration in the absence of ketosis.

What are the typical glucose levels seen in HHS?

Glucose levels in HHS are typically in the range of 600 to 2000 milligrams per deciliter, often around 1100 milligrams per deciliter.

What is the treatment approach for both DKA and HHS?

The treatment approach for both DKA and HHS involves fluid replacement, treating hyperglycemia with IV insulin, electrolyte replacement, and treating the underlying disorder.

Why is fluid replacement a priority in the treatment of DKA and HHS?

Fluid replacement is a priority to prevent cardiovascular collapse due to the profound dehydration and hypovolemia experienced by patients with these conditions.

How do patients with HHS differ in terms of mortality risk compared to DKA?

Patients with HHS have a higher risk of death due to severe volume loss, often dealing with chronically ill patients, CNS dysfunction, and potential complications such as cerebral edema, cardiovascular collapse, renal shutdown, and vascular embolism.