High blood sugar is also known as hyperglycemia. It is a condition where the level of sugar in the blood is too high. Diabetic ketoaacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome (HHNK) are two different conditions characterized by hyperglycemia.
The key difference between DKA and HHNK is the conditions associated with them. DKA is a condition that is characterized by both ketoacidosis and hyperglycemia, while HHNK is a condition that is characterized only by severe hyperglycemia.
CONTENTS
1. Overview and Key Difference
2. What is DKA
3. What is HHNK
4. Similarities – DKA and HHNK
5. DKA vs HHNK in Tabular Form
6. Summary – DKA vs HHNK
7. FAQ – DKA and HHNK
What is DKA?
DKA (diabetic ketoacidosis) is a serious condition seen in diabetic patients. This condition develops when people cannot produce enough insulin. Without insulin, the body starts to break down fat as fuel. This causes building up of acids known as ketones, which lead to diabetic ketoacidosis. The typical symptoms of this condition may include being very thirsty, urinating often, vomiting, having stomach pain, being weak or tired, being short of breath, having fruity-scented breath, and being confused. DKA usually happens after an illness, problems with insulin therapy, physical or emotional trauma, heart attack or stroke, pancreatitis, pregnancy, alcohol or drug misuse (particularly cocaine), and certain medications (corticosteroids and diuretics).
DKA can be diagnosed through physical examinations, blood tests, blood electrolyte tests, urinalysis, chest X-rays, and electrocardiograms. Furthermore, treatment options for DKA may include replacing fluids, replacing electrolytes, and receiving insulin.
What is HHNK?
Hyperosmolar hyperglycemic state (HHS) or HHNK (hyperosmolar hyperglycemic nonketotic syndrome) is a life-threatening condition in type 2 diabetic patients. This condition arises when blood glucose levels are too high for a long period, leading to severe dehydration and confusion. The symptoms of HHNK may include very high blood sugar levels, mental changes, loss of consciousness, dry mouth, extreme thirst, frequent urination, blurred vision or loss of vision, and weakness or paralysis. HHNK can be caused by infections, stopping diabetic medications, taking certain medications (corticosteroids, thiazide diuretics, and some atypical neuroleptics), and cardiovascular issues.
HHNK can be diagnosed through physical examination, blood test, and comprehensive metabolic panel. Furthermore, treatment options for HHNK may include giving intravenous fluid, replacing electrolytes such as potassium, giving insulin to regulate blood sugar levels, and managing underlying conditions.
Similarities Between DKA and HHNK
- DKA and HHNK are two different conditions characterized by hyperglycemia.
- They can happen due to a lack of insulin.
- Both conditions can lead to complications such as confusion, coma, etc.
- They can be diagnosed through physical examination and blood tests.
- Both conditions can be treated by replacing electrolytes and receiving insulin.
Difference Between DKA and HHNK
Definition
- DKA is an acute, serious condition of hyperglycemia, ketoacidosis, and ketonuria that occurs in diabetic patients.
- HHNK is a chronic, serious condition that happens when blood sugar levels are very high for a long period of time.
Type of Diabetic Patients
- DKA is common in Type 1 diabetic patients.
- HHNK is common in Type 2 diabetic patients.
Time to Develop
- DKA develops quickly.
- HHNK develops slowly.
Causes
- DKA can be caused by illness, problems with insulin therapy, physical or emotional trauma, heart attack or stroke, pancreatitis, pregnancy, alcohol or drug misuse (particularly cocaine), and certain medications such as corticosteroids and diuretics.
- HHNK can be caused by infections, discontinuing diabetic medications, taking certain medications such as corticosteroids, thiazide diuretics, and some atypical neuroleptics, as well as cardiovascular issues.
Symptoms
- Symptoms of DKA include extreme thirst, frequent urination, vomiting, stomach pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion.
- Symptoms of HHNK include very high blood sugar levels, mental changes, loss of consciousness, dry mouth, extreme thirst, frequent urination, blurred or lost vision, and weakness or paralysis.
Diagnosis
- DKA can be diagnosed through a physical examination, blood tests, blood electrolyte tests, urinalysis, chest X-rays, and electrocardiograms.
- HHNK can be diagnosed through a physical examination, blood tests, and comprehensive metabolic panel tests.
Treatment
- Treatment for DKA includes replacing fluids, restoring electrolyte balance, and administering insulin.
- Treatment for HHNK involves administering intravenous fluids, replacing electrolytes such as potassium, giving insulin to regulate blood sugar levels, and managing underlying conditions.
The following table summarizes the difference between DKA and HHNK.
Summary – DKA vs HHNK
Hyperglycemia happens when there is too much sugar in the blood. DKA and HHNK are two different conditions characterized by hyperglycemia. However, DKA is an acute, serious condition characterized by hyperglycemia, ketoacidosis, and ketonuria. HHNK is a chronic, serious condition that happens when blood sugar levels are very high for a long period of time. Moreover, DKA occurs in type 1 diabetic patients, whereas HHNK occurs in type 2 diabetic patients. This is the summary of the difference between DKA and HHNK.
FAQ: DKA and HHNK
1. What happens when someone is in DKA?
- DKA (diabetic ketoacidosis) occurs when there is a severe lack of insulin in the body. This means the body can’t use sugar for energy and starts to use fat instead. When this happens, chemicals called ketones are released into the bloodstream.
2. What are the signs and symptoms of DKA?
- The symptoms of DKA are being very thirsty, often urinating, throwing up, having stomach pain, being weak or tired, being short of breath, having fruity-scented breath, and being confused.
3. What is the first treatment for diabetic ketoacidosis?
- DKA is treated through the restoration of extra-cellular fluid volume through the intravenous administration of a normal saline. Other treatments include replacing electrolytes and receiving insulin.
4. What is HHNK characterized by?
- This syndrome is characterized by severe hyperglycemia (over 600 mg/dL or 33 mmol/L). It also shows a marked increase in serum osmolality and dehydration without accumulation of beta-hydroxybutyric or acetoacetic ketoacids.
5. What are the treatments for HHNK?
- HHNK is a serious condition that develops slowly. It can be treated by giving intravenous fluid, replacing electrolytes such as potassium, using insulin to regulate blood sugar levels, and managing underlying conditions.
Reference:
1. Gosmanov, Aidar R. “Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.” Endotext [Internet]., U.S. National Library of Medicine.
2. Hassan, Esraa Mamdouh, et al. “Overlap of Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State.” World Journal of Clinical Cases, U.S. National Library of Medicine.
Image Courtesy:
1. “Diabetic Ketoacidosis” By Gblanchard16 – Own work (CC BY-SA 4.0) via Commons Wikimedia