Diabetic Ketoacidosis vs. Hyperosmolar Hyperglycemic Syndrome: Differences (Nursing)

by Rhonda Lawes, PhD, RN

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      Slides Nursing DKA vs HHS.pdf
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      Review Sheet Hyper vs Hypoglycemia Nursing.pdf
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      Reference List Medical Surgical Nursing and Pathophysiology Nursing.pdf
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    00:02 Charts are one of my favorite ways to study.

    00:04 So I made one for you.

    00:06 You're welcome.

    00:08 So let's take a look at it.

    00:09 This is comparing diabetic ketoacidosis to HHS.

    00:13 Now I have come up with six criteria that are important for you to know about both of these conditions.

    00:18 So let's start.

    00:19 Insulin, yeah with DKA, their type 1.

    00:24 So they're going to have a profound lack of insulin That means none.

    00:28 All right, very very scant or none.

    00:31 Their blood glucose is going to be greater than 250.

    00:36 Now the progression is going to be rapid.

    00:37 This is going to come on really really quick.

    00:40 Now there have Ketone bodies that are present in their urine in their blood.

    00:45 Remember when they can't use glucose for energy, they go after different sources, and one of the waste products of that is ketones.

    00:55 Now, there's other labs like ABGs, we're going to take a look at those and see we would expect them to be in acidosis.

    01:01 Hey, there's big clues for this in the name DKA.

    01:06 Look at the second part ketoacidosis.

    01:09 Well keto reminds us oh, there's going to be ketones.

    01:12 Acidosis reminds us there pH is going to be less than 7.35.

    01:17 So you can actually use the name to help you remember the lab work.

    01:21 Now is they're going to be osmotic diuresis/ Yes and severe dehydration.

    01:28 Now, how do I use this information on a test question? Well test questions may ask you, what are signs that the patient's treatment is effective? Whoo-hoo. What am I going to be looking for? Normal ABGs, right? I'm gonna be looking for a pH it was within normal range.

    01:45 I'm going to be looking for signs that dehydration is resolving.

    01:49 So keep that in mind.

    01:50 There's obvious ones like is blood sugar back within a normal range, but you know nursing school questions are never that straightforward or obvious.

    01:59 So when you study this way, when you know the signs and symptoms of when a patient is in DKA, you're going to be so much better prepared to answer those exam questions.

    02:10 All right, we've done DKA all the way across those six criteria.

    02:15 Now, let's compare it to HHS.

    02:17 Well in DKA in insulin, they had a profound lack of insulin.

    02:22 But we're looking at HHS, they have a skosh just a touch of insulin.

    02:28 Just enough to keep them out of something like diabetic ketoacidosis.

    02:32 Now their blood sugar is going to be higher really.

    02:37 Look at that, now these are type 2 diabetic patients who by the time they're coming in and getting help or really seeing severe symptoms.

    02:44 Look at how much higher their blood sugar is than with DKA.

    02:48 Okay now, DKA patients can get way higher than 250, but we're letting you know, this is the criteria for meeting the criteria for DKA just greater than 250 is what we would need to see.

    03:00 HHS, It's usually greater than 600.

    03:04 What about the progression? Well, if DKA is rapid, what are you going to guess? Right.

    03:11 HHS is slower.

    03:13 Ketone bodies? Absent or minimal.

    03:16 See remember, HHS go back to that insulin column.

    03:21 They have just enough insulin to be getting some of that energy into the cells.

    03:27 So they don't have the ketone bodies because they're not ripping at the fat like somebody in DKA would.

    03:33 Now other labs, they're going to have an increase in their serum osmolality and they are also going to be very dehydrated with osmotic diuresis.

    03:43 So you got this.

    03:44 This is a great summary chart for you to keep in mind the most important characteristics between DKA and HHS.

    03:53 Now, are you clear on how you use this information to get ready for an exam? Right, you have to know what normal is then you can recognize what's abnormal about HHS and DKA, and you will be ready to answer application questions.

    04:09 Now that we've looked at it as a chart.

    04:11 I want to show you a graphic kind of give you another thing to focus your brain on when you're preparing this information.

    04:18 When we're talking about the main difference between DKA and HHS, remember DKA doesn't have any insulin but HHS has just enough to keep things running.

    04:31 Look at the graphic I have for you there.

    04:33 See how there's extra glucose, those little circles with the three sugar cubes in them.

    04:38 This is Really elevated blood glucose, so we know that that glucose is going to be really high but this patient won't be in diabetic ketoacidosis.

    04:49 Why? Well, look at the number of little triangles in there.

    04:54 That's what we use to represent the insulin.

    04:57 See the high blood glucose will cause this osmotic diuresis, but we do have just enough insulin to provide energy for the patient's body.

    05:07 That's the biggest difference.

    05:09 Both DKA and HHS are going to have severe dehydration.

    05:14 They're going to have osmotic diuresis because of all the glucose you see in there.

    05:20 But the difference between DKA and HHS is this client is HHS because you see a few a little sprinkling of insulin in the blood stream.

    05:31 Okay so now you've got it.

    05:33 You've seen it as a chart and now you see it as a graphic.

    05:37 Those are the differences between between DKA and HHS.

    About the Lecture

    The lecture Diabetic Ketoacidosis vs. Hyperosmolar Hyperglycemic Syndrome: Differences (Nursing) by Rhonda Lawes, PhD, RN is from the course Diabetes Type 1 and 2: Complications and Symptoms (Nursing).

    Included Quiz Questions

    1. 7.29
    2. 7.35
    3. 7.41
    4. 7.48
    1. Serum ketones
    2. Serum osmolarity
    3. Serum creatinine
    4. Serum electrolytes
    1. Clients with HHS will have some insulin whereas clients with DKA will have no insulin
    2. Clients with HHS will be dehydrated whereas clients with DKA will not
    3. The blood glucose level in HHS is always lower than in DKA
    4. DKA is more life threatening than HHS

    Author of lecture Diabetic Ketoacidosis vs. Hyperosmolar Hyperglycemic Syndrome: Differences (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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