pediatric emergency MCQ-No10

Question 10

•Which of the following statements concerning hyperosmolar hyperglycemic non ketotic syndrome (HHNS) is TRUE?
A.The mortality rate of HHNS is less than that of DKA
B.HHNS and DKA are easily distinguishable
C.A majority of HHNS patients present with coma
D.Metabolic acidosis excludes the diagnosis
E.Seizures occur in up to 15 percent of patients with HHNS

Answer & Comments
•E
Comments:
–HHNS occurs primarily in diabetics, although most cases are undiagnosed at the time of presentation.
–The mortality of HHNS is 3-7 times greater than that for DKA.
–HHNS is characterized by severe dehydration (8–12 L deficit), hyperglycemia (greater than in DKA), and hyper-osmolality.
–In patients with HHNS, high levels of glucose occur without the ketone body formation seen in DKA. However, metabolic acidosis may occur in HHNS from other causes (eg. excessive lactic acid levels or uremia).
–Neurologic signs can be prominent in HHNS, with about 15 % of patients manifesting seizures.
–Although HHNS is frequently referred to as hyperosmolar non ketotic coma, coma occurs in fewer than 10 % of such patients.
–HHNS and DKA can be difficult to distinguish clinically.