Diabetic Ketoacidosis vs. Hyperosmolar Hyperglycemia Non-Ketotic Syndrome

Hyperosmolar hyperglycemia non-ketotic syndrome (HHNS) is a life-threatening complication that develops from high blood glucose levels. It is also referred to as hyperosmolar coma, and mostly affects patients with type 2 diabetes. It develops due to infections such as urinary tract infection and pneumonia (French et al., 2019). Untreated diabetes and chronic conditions such as heart failure also significant causes of HHNS. It is also referred to as a diabetic coma since it can cause unconsciousness. HHNS is a rare condition that accounts for only 1 percent of people admitted to hospitals with diabetes complications (Pasquel et al., 2020).   Patients with HHNS present with over 600mg/dl (French et al., 2019), high glucose levels, fever, confusion, lethargy, extreme thirst, and blurry vision. This condition rarely affects people who have not been diagnosed with diabetes.

Diabetic ketoacidosis (DKA) is a condition that develops due to inadequate insulin in the body caused by metabolism disorders (Pasquel et al., 2020).  It is an acute condition that is life-threatening. It presents with dyspnea, fever, labored respiration, dry skin, and malaise (Desai et al., 2018).  The condition mainly affects people with type 1 diabetes and is caused primarily by infection, undiagnosed and poorly managed diabetes

The Similarities and Differences

DKA and HHNS are both acute, deadly complications that call for emergency care and are both the leading causes of death in patients with diabetes (Pasquel et al., 2020). Timely management for both conditions can be successful. They are both caused by infection and mismanagement of the condition.

HHNS is a condition that develops gradually, while DKA happens suddenly. While DKA is common in patients with type 1 diabetes and HHNS is commonly affected by type 2 diabetes (French et al., 2019).   Patients with DKA are treated with insulin administration, while HHNS is treated with therapy for infection control and rehydration. In DKA, the glucose levels are >300 mg/dl, while in HHNS, they are >600mg/dl (Desai et al., 2018). Serum osmolality in DKA is 280-350mOsm/L while>350mOsm/L in HHNS (Desai et al., 2018).  Urine ketones and serum are present in DKA and absent in HHNS. Lastly, HHNS has a high mortality rate.