Introduction to DKA vs HHS

Diabetic ketoacidosis (DKA) and Hyperosmolar Hyperglycemic Syndrome (HHS) are two complications that can occur in a client with diabetes. Both complications can occur from hyperglycemia, leading to an imbalance of acids.

Let’s look at the difference, precipitating factors, and manifestations.

Differences between DKA and HHS

Both conditions result from an insulin deficiency that causes hyperglycemia. Insulin is a hormone that helps the body use glucose for energy. As a result of this deficiency, the liver starts to break down fats for energy instead of sugar, causing a buildup of ketones in the blood and urine.

DKA is more common in type one diabetes clients, and HHS is more common for those with type two diabetes.

Clients in the early stages of DKA and HHS may present with the same manifestations, such as hyperglycemia, excessive thirst, and frequent urination. Although both conditions may share some similarities, there are distinct differences. Nurses must carefully assess their clients, record a thorough history and physical, evaluate, and report findings to differentiate between DKA and HHS. Both of these complications can be life-threatening.

DKA vs HHS Symptoms

DKA vs HHS Diagnostic Criteria (with Lab Values)

DKA Diagnostic Criteria

• Associated symptoms (nausea, vomiting, abdominal pain, etc.)
• Hyperglycemia > 250 mg/dl
• Ketonemia > 3 mmol/L (with ketonuria present)
• Acidosis with a pH < 7.3, bicarbonate level < 15 mmol/L (or both)
• Blood glucose level > 250 mg/dL (13.9 mmol/L)
• Anion gap > 12 mEq/L
• Blood pH <7.3
• Blood bicarbonate <15 mEq/L (24 mg/dL)
• Serum ketones > 3+
• Respiratory rate >20 breaths per minute

HHS Diagnostic Criteria

• Presence of ketones in urine or blood
• Hyperglycemia: > 600 mg/dL
• Osmolarity: > 320 mOsm/L (Hyperosmolarity)
• BUN: elevated (>18 mg/dL)
• Blood glucose level > 600 mg/dL
• A fasting blood glucose concentration ≥ 250 mg/dL (13.9 mmol/L) or a random blood glucose concentration ≥ 200 mg/dL (11.1 mmol/L)
• Anion gap >10 meq/L
• Sodium level >150 mEq/L
• Blood urea nitrogen ≥ 20 mg/dL

DKA vs HHS Treatment

With DKA clients, the objective is to stabilize the blood sugar. This typically includes administering insulin and fluids, as well as monitoring vitals. With HHS clients, the main objective is treating dehydration and electrolyte imbalances.

A treatment plan for both DKA and HHS looks like:

Monitoring

• Vital signs (including blood pressure, pulse rate, and respiratory rate)
• Urine output and intake
• Signs and symptoms of dehydration (dry mouth or tongue, decreased skin elasticity, sunken eyes, confusion, and lethargy)

Administering

• IV fluids for dehydration
• Insulin

Providing

• Oxygen therapy (if needed)
• Electrolytes and potassium supplements

DKA vs HHS Conclusion

When a client doesn’t have enough insulin in their body, two complications can occur: diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic syndrome (HHS). Although they may appear different on lab testing, both conditions can result in an imbalance of acids and bases in the blood.

Insulin (a type of hormone) aids the body’s utilization of glucose as fuel. Without it, the body switches to burning fat for energy (instead of sugar), resulting in an accumulation of ketones in the blood and urine.

One of the main distinctions between DKA and HHS is that DKA usually results in acidosis and HHS usually has higher blood glucose.

Sources

https://www.healthline.com/health/diabetes/hhns-vs-dka
https://www.myamericannurse.com/dka-and-hhs/
https://www.ncbi.nlm.nih.gov/books/NBK278976/