Sandbox: HS: Difference between revisions

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The exact incidence of HHS is not known, but it is estimated to account for <1% of hospital admissions in patients with diabetes (1)
{{familytree | boxstyle= text-align: Center; | | | |B01| | | | |B01='''''Preinsulin era'''''<br> •The treatment modalities used for diabetic coma include blood transfusion, castor oil with potassium citrate, and saline solutions with sodium carbonate among other therapies.
 
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Centers for Disease Control and Prevention. Diabetes Public Health Resource: Diabetes Data & Trends. Available at: http://www.cdc.gov/diabetes/statistics/mortalitydka/fratedkadiabtotals.htm
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Most cases of HHS are seen in elderly patients with type 2 diabetes; however, it has also been reported in children and young adults (2). The overall mortality rate is estimated to be as high as 20%, which is about 10 times higher than the mortality in patients with diabetic ketoacidosis (DKA) (3–5).
{{familytree | boxstyle= text-align: Center; | | | |B01| | | | |B01= '''''1930–1950'''''<br> •The usual practice was to use insulin in 20–100 units i.v. or s.c. bolus followed by 20 units s.c. every 30–60 min depending on glucosuria.
 
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The reported mortality is between 10 and 20%, which is about 10 times higher than the mortality rate in patients with diabetic ketoacidosis (DKA).
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Despite the severity of this condition, no prospective, randomized studies have determined best treatment strategies in patients with HHS, and its management has largely been extrapolated from studies of patients with DKA. There are many unresolved questions that need to be addressed in prospective clinical trials regarding the pathogenesis and treatment of pediatric and adult patients with HHS.
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Population-based data are not available for HHS. The rate of hospital admissions for HHS is lower than the rate for DKA, and accounts for less than 1 percent of all primary diabetic admissions [1,3-5].
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{{familytree | boxstyle= text-align: Center; | | | |B01| | | | |B01= '''''1950–1970s'''''<br> • In that period, the insulin was given as 2 units/kg bolus of crystalline insulin; up to 920 units in the first 7 h.
The mortality rate for hyperglycemic crisis declined between 1980 and 2009
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{{familytree | boxstyle= text-align: Center; | | | |B01| | | | |B01= '''''Early 1970s'''''<br> • Insulin was given as low-dose insulin regimens with Regular insulin 0.1 units/kg i.v. followed by 0.1–0.3 units/h i.v., s.c., or i.m.
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{{familytree | boxstyle= text-align: Center; | | | |B01| | | | |B01= '''''1990s'''''<br> • Insulin was administered as 0.1 units/kg i.v. bolus, then 0.1 units/kg/h as continuous infusion until glucose level <13.8 mmol/L (250 mg/dL)
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{{familytree | boxstyle= text-align: Center; | | | |B01| | | | |B01= '''''2004–2009'''''<br> • ADA consensus for treatment of DKA and HHS in adult patients according to which Initial bolus (0.1 units/kg i.v.), followed by 0.1 units/kg/h until glucose <250 mg/dL, then reduce insulin by 50%
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Revision as of 20:19, 24 September 2017

The exact incidence of HHS is not known, but it is estimated to account for <1% of hospital admissions in patients with diabetes (1)


Centers for Disease Control and Prevention. Diabetes Public Health Resource: Diabetes Data & Trends. Available at: http://www.cdc.gov/diabetes/statistics/mortalitydka/fratedkadiabtotals.htm

Most cases of HHS are seen in elderly patients with type 2 diabetes; however, it has also been reported in children and young adults (2). The overall mortality rate is estimated to be as high as 20%, which is about 10 times higher than the mortality in patients with diabetic ketoacidosis (DKA) (3–5).

The reported mortality is between 10 and 20%, which is about 10 times higher than the mortality rate in patients with diabetic ketoacidosis (DKA). 

Despite the severity of this condition, no prospective, randomized studies have determined best treatment strategies in patients with HHS, and its management has largely been extrapolated from studies of patients with DKA. There are many unresolved questions that need to be addressed in prospective clinical trials regarding the pathogenesis and treatment of pediatric and adult patients with HHS.
Population-based data are not available for HHS. The rate of hospital admissions for HHS is lower than the rate for DKA, and accounts for less than 1 percent of all primary diabetic admissions [1,3-5].

The mortality rate for hyperglycemic crisis declined between 1980 and 2009

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