Hyperosmolar nonketotic hyperglycemia syndrome or also known as Hyperosmolar Hyperglycaemic State (HHS) is experienced by people who have very high glucose levels or diabetics. This dangerous condition that can be triggered by infection or other diseases is more common in people with type 2 diabetes, but it can also occur in all types of diabetes, especially the elderly.
Diabetes is a chronic disease characterized by high blood sugar levels. This disease can cause various complications, and some of them are fatal namely diabetic ketoacidosis and hyperketmolar hyperosmolar hyperglycemia. Although it is relatively less common than diabetic ketoacidosis, this condition has a higher mortality rate, reaching 5-10%.
Hyperosmolar nonketotic hyperglycemia can occur when a person's blood sugar level is above 33 mmol / l (600 mg / dl) for a long time and there are not enough drugs to reduce this level. This condition can also occur if the use of diabetes medications is stopped due to swallowing disorders or other medical conditions. This emergency condition is more common in the elderly with chronic type 2 diabetes who are prone to dehydration, especially those who have decreased sensitivity to thirst or swallowing disorders. The body of a person with hyperketmolar non-ketotic hyperglycemia will continue to carry excess sugar into the urine, thereby making the urine color change and urinating frequently.
This complication involves high blood sugar levels without the presence of ketones as a by-product of the breakdown of fatty acids. In addition to high blood sugar levels, this condition can trigger dehydration and reduced level of consciousness. Sometimes this situation is also accompanied by a buildup of ketones, but ketone buildup generally occurs in diabetic ketoacidosis. The buildup of ketones in diabetic ketoacidosis occurs when insulin is difficult to work or insulin resistance occurs so that glucose as the main source of energy in body cells can not be used. As a result, the body uses alternative pathways to produce energy by processing fat which results in ketone production. Too high ketone production can cause blood acid-base imbalance (ketoacidosis).
In nonketotic hyperosmolar hyperglycemia, the main condition that causes problems is an increase in the thickness and concentration of substances such as blood sugar and other substances (hyperosmolarity) in the blood, because blood sugar is too high or uncontrolled. This situation coupled with dehydration will cause water in the tissues and organs of the body to be pulled out into the blood that experiences hyperosmolarity, as a result, the body's cells will experience metabolic disorders and can cause death if not treated immediately.
Therefore, diabetics need to recognize the symptoms of hyperketmolar nonketotic hyperglycemia in order to get early treatment such as severe thirst, dry mouth, rising blood sugar levels, fever, loss of vision, hallucinations, warm skin but not sweating, nausea, drowsiness or confusion, severe weight loss body, and feeling weak on one side of the body. If you have diabetes and you have these symptoms, go to the doctor or the Emergency Department at the nearest hospital to get treatment, because this condition is an emergency for diabetics.
This condition is more at risk for people with diabetes with dementia, people who use illegal drugs, children who consume corticosteroids for a long time, and sufferers of gastroenteritis or diarrhea. Poor kidney function can also be a risk factor for nonketotic hyperosmolar hyperglycemia. The use of drugs such as diuretics, statins, immune system suppressants, antiarrhythmics, antiepileptics, antopsychotics, antihypertensives, beta blockers and calcium channel blockers, H2 antagonists to treat gastric disease, and anesthesia or anesthesia have the potential to cause this condition.
Generally nonketotic hyperosmolar hyperglycemia is motivated or triggered by the following conditions:
- Untreated diabetes.
- Infections such as pneumonia, cellulitis, or urinary tract infections.
- Certain diseases such as stroke or heart disease.
- Misuse of certain drugs such as cocaine, alcohol, amphetamine.
- Take medications that increase fluid loss or reduce the body's insulin effects.
Untreated hyperosmolar hyperosmolar hyperglycemia will make the sufferer's body feel weak, impaired vision, or even cramps in the legs, so it needs total rest. As a result of this condition, dehydration can occur especially if the patient does not consume adequate fluids regularly.
Patients with this condition need to get a complete and detailed examination. The doctor will carry out general physical examinations and supporting examinations, such as complete blood tests, blood sugar levels, HbA1C, electrolyte tests, blood gas analysis, ECG, kidney and liver function, urine analysis, ketone examination, BUN (Basal Urea Nitrogen), X-rays chest and abdomen, and head CT scans if there is a decrease in consciousness.
Treatment for the underlying disease is needed. The general treatment of dehydration in nonketotic hyperosmolar hyperglycemia needs to be dealt with immediately by various ways such as infusion to provide isotonic sodium chloride liquid, airway management and safety, and medication. Once dehydration has been treated, blood pressure will improve, so does circulation, blood sugar levels, and urine production.
In patients with HHS with decreased awareness, intubation will be needed to install breathing apparatus to secure and optimize respiratory function. To control blood sugar, insulin injections will be needed through an IV or fat tissue. Providing insulin to reduce blood sugar levels in this emergency situation must be done by a doctor and monitored at the hospital. Conditions that are at high risk of causing this death require treatment in an intensive care unit (ICU).
If not treated immediately, dehydration can cause seizures, coma, and even the most fatal complications, namely death. One in four sufferers of this condition experience seizures. In addition, tachycardia or heart beating faster than usual is one result of dehydration. Other complications that can occur in HHS include myocardial infarction or heart attack, Acute Respiratory Distress Syndrome (ARDS), pulmonary embolism, deep vein thrombosis (DVT), malfunctioning of various organs, and swelling of the brain.
Managing diabetes so that it does not become severe is one of the first steps to prevent nonketotic hyperosmolar hyperglycemia, which is to check sugar levels regularly, live a healthy lifestyle, and routinely control it to the doctor for regular health checks. Diabetics and those around them need to know about this disease and dangerous signs and symptoms that need to be anticipated. Good knowledge about this disease will have a good impact on you to recognize the symptoms of various dangerous complications in order to get optimal early treatment. Therefore, consult your doctor about diabetes and seek treatment at the nearest hospital immediately if there are signs of danger that accompany it.
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