🩺 DKA vs HHS: NCLEX Emergency Endocrine Breakdown
DKA and HHS are both life-threatening diabetes emergencies — but they have key differences in cause, symptoms, and treatment.
NCLEX loves to ask you to distinguish between them quickly.
This blog breaks it down using a simple KOTC table, mnemonic, and critical nursing steps.
🧪 DKA vs HHS Comparison Table
| Feature | DKA | HHS |
|---|---|---|
| Type of Diabetes | Type 1 | Type 2 |
| Onset | Rapid (hours to 1 day) | Slow (days to weeks) |
| Glucose Level | >250 mg/dL | >600 mg/dL |
| Ketones | Present (blood and urine) | Minimal or none |
| Acidosis | Yes (pH <7.3) | No significant acidosis |
| Symptoms | Kussmaul breathing, fruity breath, abdominal pain | Severe dehydration, confusion, seizures |
| Mental Status | Alert to drowsy | Stupor, coma common |
🧠 NCLEX Tip: Think About Dehydration!
Both conditions involve extreme fluid loss, but HHS typically causes more profound dehydration and mental status changes due to very high glucose levels.
📌 Key Nursing Interventions
Rehydrate aggressively with IV fluids (NS first)
Start insulin drip (regular insulin only)
Correct electrolytes, especially potassium
Monitor labs: glucose, potassium, ABGs, serum osmolality
Treat underlying cause (infection, MI, missed insulin)
⚡ Always correct potassium before giving insulin — insulin drives potassium into cells, risking hypokalemia.
🧠 NCLEX-Style Question
A patient with Type 2 diabetes presents with glucose 780 mg/dL, dry mucous membranes, and confusion. What is the most likely diagnosis?
✅ Answer: Hyperosmolar Hyperglycemic State (HHS).
💡 Mnemonic: “SUGAR”
S – Start IV fluids
U – Use regular insulin
G – Gradually lower blood sugar
A – Add potassium if needed
R – Recognize differences (DKA = ketones; HHS = extreme dehydration)
📲 Boost Your Endocrine Mastery with King of the Curve
🩸 DKA/HHS flashcards
🎯 Endocrine system QBank
📖 Rapid review mnemonics
Visit kingofthecurve.org/studyscience
🏁 Final Thoughts
Knowing DKA vs HHS can save lives — and a lot of NCLEX points.
Focus on glucose levels, ketones, acidosis, and mental status changes — and you’ll ace these endocrine emergency questions.
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