Source -

Here’s the CCRN® style question:

Which of the following statements about HHNK and DKA is false?

A. DKA is primarily seen in patients with type 1 diabetes whereas HHNK is seen in patients with type 2 diabetes.
B. Clinical presentation of HHNK includes signs and symptoms including weakness, decreased skin turgor, shallow breathing, polyuria, and hypotension.
C. HHNK produces higher serum glucose levels than DKA.
D. DKA and HHNK both require the same amount of intravenous insulin per hour based on patient body weight.

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Seriously, why so many acronyms and different ways to say basically the same thing. Sometimes I feel like medical professionals just make up this stuff up in order to feel superior or something.

Let me give you a quick rundown behind the meaning of these acronyms:

  • HHNK - hyperosmolar hyperglycemic non-ketoacidosis

  • HHNC - hyperglycemic hyperosmolar nonketotic coma

  • HHNS - hyperosmolar hyperglycemic nonketotic syndrome

  • HHS - hyperosmolar hyperglycemic syndrome

Hyperosmolar hyperglycemic non-ketoacidosis (HHNK) is the way they refer to it on the CCRN® -


So that’s the way we are going to refer to this phenomena from here on out.

…What exactly is HHNK?

Let’s start with the 3 H’s. These patients have 3 hallmark pathophysiologies:

1. Hyperglycemia
2. Hypovolemia
3. Hyperosmolality

Let me see if I can paint you a picture of how these 3 are tied together:

Patients develop high blood sugar related to uncontrolled diabetes type

At some point the renal threshold is met and sugar starts coming out in the urine. ‘Renal threshold’ is the point at which a substance in the blood has reach levels high enough to be excreted through the kidneys.

If you think back to fluid and electrolytes, “where sugar/salt is, water follows”.

So now we have lots of water leaving our patients body causing dehydration (aka hypovolemia).

The average patient in HHNK is usually short about 8 to 10 liters from baseline.

Now that a massive amount of water is gone - what’s left in our circulation? Well, all sorts of stuff. Lots of ‘stuff’ with basically no fluid, leaves you with a super high concentration. (hyperosmolar)

Congratulations - your patient has now reached an a hyperosmolar hyperglycemic state.

Understanding the Signs and Symptoms [Plus Infographic]

Here are the signs and symptoms of HHNK according to

Blood sugar level of 600 milligrams per deciliter (mg/dL) or 33.3 millimoles per liter (mmol/L) or higher

Excessive thirst

Dry mouth

Increased urination

Warm, dry skin


Drowsiness, confusion


Vision loss



The infographic below shows the S&S of DKA:


Source -

Okay so, how is HHNK different from DKA?

Check out the video below:

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