What is the Difference Between DKA and HHS

The key difference between DKA and HHS is that Diabetic ketoacidosis (DKA) is a complication of diabetes mainly characterized by hyperglycemia and ketoacidosis. At the same time, Hyperosmolar Hyperglycemic State (HHS) is a complication of diabetes mainly characterized by severe hyperglycemia and hyperosmolarity.

Diabetes or diabetes mellitus refers to a group of diseases that affect the way the human body uses blood sugar (glucose) as the energy source. It leads to excess sugar in the blood, which causes serious health problems. Long-term (chronic) complications of diabetes develop gradually and include cardiovascular disease, diabetic neuropathy, diabetic nephropathy, diabetic retinopathy, foot damage, skin and mouth conditions, hearing impairment, Alzheimer’s disease, depression-related diabetes, DKA (diabetic ketoacidosis), HHS (hyperosmolar hyperglycemia state).

CONTENTS

1. Overview and Key Difference
2. What is DKA (Diabetic ketoacidosis)
3. What is HHS (Hyperosmolar Hyperglycemic State)
4. Similarities – DKA and HHS
5. DKA vs HHS in Tabular Form
6. Summary – DKA vs HHS

What is DKA?

Diabetic ketoacidosis (DKA) is a serious complication of diabetes. In diabetes, without insulin, the body begins to break down fat as fuel. This causes the build-up of acids in the blood called ketones. If not managed properly, this acid build-up leads to diabetic ketoacidosis. The symptoms of DKA may include being thirsty, frequent urination, feeling a need to throw up, stomach pain, weakness or tiredness, shortness of breath, fruity-scented breath, and confusion. Diabetic ketoacidosis usually happens due to illness (pneumonia and urinary tract infection), a problem with insulin therapy, physical or emotional trauma, pancreatitis, pregnancy, alcohol or drug misuse, and certain medications such as corticosteroids and diuretics. The risk factors of DKA include having type 1 diabetes and missing insulin doses.

Moreover, DKA can be diagnosed through physical examination, blood tests (blood sugar, ketone level, and blood acidity) and blood electrolyte tests, urinalysis, chest X-ray, and electrocardiogram. Furthermore, DKA can be treated through fluid replacement, electrolyte replacement, and insulin therapy.

What is HHS?

Hyperosmolar hyperglycemic state (HHS) is a life-threatening complication of type 2 diabetes. HHS usually happens when the blood glucose (sugar) level is too high for a long period. Therefore, HHS ultimately leads to severe dehydration and confusion. The other symptoms of HHS may include very high blood sugar levels (over 600 mg/dL or 33 mmol/L), delirium, experiencing hallucinations, loss of consciousness, dry mouth, polydipsia, frequent urination, blurred vision, weakness or paralysis in one side of the body.

HHS can be caused by infections (pneumonia, urinary tract infections, and sepsis), stopping diabetes medications, certain medications such as corticosteroids, thiazide diuretics, and some atypical neuroleptics, and cardiovascular issues like sudden and severe cardiovascular conditions (stroke, pulmonary embolism, or heart attack). The risk factors for HHS include having poorly managed diabetes (type 2 diabetes), being older than 65, and having other health issues like an infection, illness, or a heart problem.

Moreover, HHS can be diagnosed through physical examination and blood tests such as a comprehensive metabolic panel. Furthermore, treatment options for HHS include fluids to hydrate the body, electrolytes (such as potassium) to balance the minerals in the body, and insulin to regulate the blood sugar levels in the body.

What are the Similarities Between DKA and HHS?

• DKA and HHS are two different diabetes-associated complications.
• Both may have similar symptoms, such as high blood sugar levels, weakness or tiredness, etc.
• Both may be diagnosed through physical examinations and blood tests.
• They are treated through intravenous fluid replacement and insulin therapy.

What is the Difference Between DKA and HHS?

DKA is a complication of diabetes that is mainly characterized by hyperglycemia and ketoacidosis, while HHS is a complication of diabetes that is mainly characterized by severe hyperglycemia and hyperosmolarity. Thus, this is the key difference between DKA and HHS. Furthermore, the risk factors for DKA include having type 1 diabetes and missing insulin doses. On the other hand, the risk factors for HHS include having poorly managed diabetes (type 2 diabetes), being older than 65, and having other health issues like an infection, illness, or heart problems.

The infographic below presents the differences between DKA and HHS in tabular form for side-by-side comparison.

Summary – DKA vs. HHS

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body does not effectively use the insulin it produces. Type 1 diabetes is due to a deficiency in insulin production, while type 2 diabetes due to the body stopping using insulin properly. Diabetes can also cause complications. Therefore, DKA and HHS are two different diabetes-associated complications. DKA happens due to the excessive presence of ketones in the blood. On the other hand, HHS happens due to a long-time high blood glucose (sugar) level. So, this summarizes the difference between DKA and HHS.

Reference:

1. “Diabetic Ketoacidosis.” Centers for Disease Control and Prevention.
2. Brutsaert, Erika F. “Hyperosmolar Hyperglycemic State (HHS) – Endocrine and Metabolic Disorders.” MSD Manual Professional Edition.

Image Courtesy:

1. “Hyperglycemia” By Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. – Own work (CC BY 3.0) via Commons Wikimedia
2. “Diabetic ketoacidosis concept map” By Mahatef – Zoom out – Pharmacotherapy Website (CC BY 3.0) via Commons Wikimedia