Talk:Hyperosmolar hyperglycemic state

I
I would just like to point out an inconsistency in the first paragraph. It is mentioned that an alternative name is "Hyper-Osmolar Non-Ketotic Acidosis".

This is in fact false, the correct form is "Hyper-Osmolar Non-Ketotic State" (reference: Kumar & Clark - "Clinical Medicine") or "Hyper-Osmolar Non-Ketotic Coma", often simply abbreviated HONK (this is in fact the most common abbreviation for the condition in the UK.)

Acidosis to the best of my medical knowledge (I am a junior doctor in the UK) does not occur in HONK as part of the disease process. It may potentially arise indirectly as in any critical illness, for instance if the condition progresses into renal failure, thereby producing acidosis secondary to renal failure (which is possible given that diabetics may have a degree of chronic renal failure secondary to diabetes in the first place). Also the development of a hyperchloraemic acidosis is possible, but as a result of the treatment, rather than the disease process itself.

The development of acidosis in Diabetic Ketoacidosis (which is the other major diabetic emergency that occurs in type 1 Diabetics), is predominantly due to the formation of Ketone bodies. These are formed in the mitochondria from the catabolism of fatty-acids in response to glucose starvation, (as there is no insulin to drive glucose from the blood into the cells) and their accumulation produces a metabolic acidosis. In HONK (which is more common in type 2 diabetes, where low levels of insulin activity are still present, albeit subnormal), the presence of even minimal insulin action deters the formation of ketone bodies and therefore the formation of a metabolic acidosis.

Therefore the term HONK acidosis is incorrect.

Incidentally, the term "Ketosis" (as opposed to "Ketoacidosis") refers to the presence of Ketones in the plasma, in the abscence of acidosis, so the "Non-ketotic" part of the name itself implies the abscence of ketones (let alone acidosis) as part of the disease process; to therefore have called it "HONK acidosis" would have been in many ways an oxymoron.

Name
Hyperosmolar Hyperglycemic State (HHS) - or Hyperosmolar Hyperglycaemic State for all of us not in America - is the current term for this condition. http://www.emedicine.com/emerg/TOPIC264.HTM has the information if you want a link. Maybe this should be updated? Slaanesh17 (talk) 10:06, 14 September 2008 (UTC)

Hyperglycemic Dehydration Syndrome?
Hyperglycemic Dehydration Syndrome?

Change of name
I have now moved this article to the current name for this condition. This reflects a change in nomenclature for more than a decade, and while HONK sounds catchy we wouldn't want to use obsolete terminology.

This is the recent guideline published by NHS Diabetes and the JBDS. Would be worth including. JFW &#124; T@lk  14:00, 18 October 2012 (UTC)