title: Expedited diagnosis and management of inpatient hyperosmolar hyperglycemic nonketotic syndrome.
abstract: OBJECTIVE
  This practice improvement project was formulated to determine accuracy rate in differentiating between two hyperglycemic crises (diabetes ketoacidosis [DKA] and hyperosmolar hyperglycemic nonketotic syndrome [HHNKS]) in a clinical population of individuals who manifested hyperglycemia and diabetes mellitus (DM). We hypothesized that HHNKS was commonly misdiagnosed as DKA. Our primary aim was to determine frequency of correct HHNKS diagnoses. A second aim was to review the literature and present an evidence-based protocol to assist providers with the differential diagnosis of HHNKS from DKA.
  
  
  METHODS
  Electronic health records (N = 911) were selected by ICD-9 codes for hyperglycemia, DKA, and HHNKS. A retrospective record review indicated n = 436 met the blood glucose level depicting HHNKS. Additional laboratory findings were compared with diagnostic criteria from the literature.
  
  
  CONCLUSIONS
  HHNKS was commonly misdiagnosed and mismanaged as DKA. Only n = 9 (5%) patients with type 2 DM were correctly diagnosed and managed as having HHNKS. Of the records misdiagnosed with DKA, 74 (39%) actually manifested HHNKS clinical features. Of these, n = 24 (36%) were readmitted within 2 weeks.
  
  
  CONCLUSIONS
  Early recognition of HHNKS is essential for appropriate condition management. HHNKS-specific algorithms are essential for expediting accurate diagnosis, managing appropriately, minimizing mortality, reducing stay length, and avoiding readmissions.
authors: Department of Nursing, Wallace State Community College, Warrior, Alabama.
authors: Darlene G
authors: DG
authors: McCombs
authors: Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama.
authors: Susan J
authors: SJ
authors: Appel
authors: Department of Glycemic Control, St. Vicents Health System, Birmingham, Alabama.
authors: Marcie E
authors: ME
authors: Ward
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000407:Alabama; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000175:diagnosis* / Q000451:nursing; D003953:Diagnosis-Related Groups; D005260:Female; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000097:blood / Q000175:diagnosis* / Q000451:nursing; D008297:Male; D008875:Middle Aged; D009733:Nursing Diagnosis; D012189:Retrospective Studies; D055815:Young Adult