Summary
Highlights
The video introduces the comparison between DKA and HHNS, emphasizing that DKA is common in Type 1 diabetes and HHNS in Type 2. DKA occurs when there is no insulin, forcing the body to burn fat into acidic ketone bodies. HHNS involves some insulin, so the body burns sugar, preventing ketone production.
DKA commonly results from the three S's: Sepsis (infection, the number one cause), Stress (like surgery), or Skipping insulin. HHNS in older patients is typically caused by illness and infections.
For DKA, the acronym DKA helps remember symptoms: D for Dry body and high sugar (250-500). K for Ketones and Kussmaul respirations (deep, rapid, fruity-smelling breath due to metabolic acidosis). A for Abdominal pain and Acidosis (pH 7.35 or less).
For HHNS, remember the triple H's: Higher sugar (over 600) with Higher fluid loss (extreme dehydration), and Head changes (neurological manifestations like confusion). Key differences from DKA include no abdominal pain, no ketones, no acidosis, and a slower onset. Potassium levels are typically stable in HHNS.
Treatment for DKA also uses the acronym DKA: D for Dehydration (prioritize fluid replacement with 0.9% normal saline). K to Kill the sugar slowly (hourly blood sugar checks, IV regular insulin bolus then drip, and adding dextrose when sugar drops below 200 or ketones resolve). A to Add potassium during IV insulin administration, even if levels are normal, to prevent a crash.
Potassium management involves heart monitoring, never pushing potassium, administering a maximum of 10-20 ml per hour, and using an IV pump. High potassium (over 5.0) shows peaked T-waves and ST elevations, while low potassium (below 3.5) shows flat T-waves, ST depression, and U-waves.
Treatment for HHNS involves H for Hydration first (0.9% normal saline) and S to Stabilize the sugar slowly with IV regular insulin, similar to DKA. Potassium addition is typically not as critical in HHNS compared to DKA. Reassessing hydration status involves checking blood pressure, capillary refill, skin condition, and urine output.