HNS vs DKA

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Sugi

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Im confused as to the difference between HNS and DKA, primarily the presentation.

What I know:
HNS is usually brought on by an acute illness
DKA is brought on by lack of insulin and increased glucose levels
With HNS, ketosis is absent
DKA ketosis is present (obviously)
HNS occurs with type 2 diabetes
DKA occurs with type 1 diabetes (primarily)

What I would like to know:
1. What is the difference in the field?
2. How can you tell the difference other than HPI?

Also, to confirm for my own sake, DKA happens when insulin is completely absent and/or relatively absent, however with HNS, insulin is still present (hence the lack of ketosis, as insulin inhibits lipolysis). Is that correct?
 
Shishkabob

Shishkabob

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If your glucometer goes high enough (instead of just saying 'high'), HHNK tends to be much higher in BGL than DKA. HHNK also tends to be a longer onset (usually days to weeks) while DKA tends to be much shorter in onset. Also, even though we don't have direct access to labs in the field usually, HHNK tends to not affect the pH of blood as much as DKA. Not to mention the acetone smell that might accompany DKA, but not HHNK.

However, no matter what it is, it's treated the same way by us in the field which is on the order of treating the hypovolemia / dehydration that might be present.




PS-- you don't have to have DM to get HHNK, as non-diabetics can as well.
 
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Sugi

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[edit] Thanks Linuss, you answered my question![/edit]
 
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Sugi

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When I was reading on HNS, it said that it usually occurs with an acute illness such as an infection, MI or stroke. But you said HHNK has a longer onset of action than DKA? I dont think I understand.
 
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