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DKA vs. HHNK: What's the Difference?

Edited by Janet White || By Harlon Moss || Updated on October 13, 2023
DKA (Diabetic Ketoacidosis) and HHNK (Hyperosmolar Hyperglycemic Nonketotic Syndrome) are both serious diabetic complications, with DKA involving high ketones and acidosis and HHNK featuring extremely high blood glucose without significant ketosis.

Key Differences

DKA, or Diabetic Ketoacidosis, involves a critical build-up of ketones in the bloodstream, leading to acidosis. In contrast, HHNK, Hyperosmolar Hyperglycemic Nonketotic Syndrome, distinguishes itself by extremely high blood glucose levels without significant ketosis.
DKA commonly presents in individuals with Type 1 Diabetes due to an inadequate insulin level, which hampers glucose utilization. Alternatively, HHNK typically occurs in older individuals with Type 2 Diabetes, oftentimes when another illness or stressor inhibits insulin effectiveness.
Symptoms of DKA can include frequent urination, high blood sugar levels, and high levels of ketones in the urine. Differently, HHNK may present with symptoms like extreme thirst, fever, dry skin, and altered mental status, frequently developing more slowly than DKA.
DKA is usually characterized by a rapid onset and might be triggered by factors like missed insulin doses or infections. On the flip side, HHNK typically manifests more gradually, potentially over several days to weeks, often precipitated by dehydration or an underlying illness.
Management of DKA usually involves rehydration, insulin therapy, and electrolyte replacement to manage the acidosis. Conversely, management of HHNK also involves rehydration and correcting the hyperglycemia, but with a keen eye on managing osmolarity and avoiding rapid changes.

Comparison Chart

Primary Issue

High ketones leading to acidosis.
Extremely high blood glucose without significant ketosis.

Common Patient Type

More common in Type 1 Diabetics.
Often found in older individuals with Type 2 Diabetes.


Includes high ketones, high glucose, and frequent urination.
Involves extreme thirst, high glucose, and possible confusion.


Generally has a rapid onset.
Typically develops more gradually than DKA.

Management Focus

Involves managing ketosis and acidosis.
Primarily focused on managing hyperglycemia and osmolarity.

DKA and HHNK Definitions


Can be identified by symptoms like excessive thirst, urination, and fruity breath odor.
The healthcare team suspected DKA due to her pronounced fruity breath.


Typically occurs in individuals with Type 2 Diabetes, especially the elderly.
After experiencing frequent urination and confusion, my grandfather, who has Type 2 Diabetes, was diagnosed with HHNK.


A diabetic complication characterized by high ketones and acidosis.
The patient was admitted for DKA after forgetting several insulin doses.


May manifest with symptoms like profound dehydration, altered mental status, and seizures.
Due to her dehydration and altered consciousness, physicians considered an HHNK diagnosis.


Requires urgent medical management including hydration and insulin therapy.
Emergency measures for DKA were initiated, stabilizing the patient's condition.


A severe diabetic complication characterized by extreme hyperglycemia without ketosis.
The elderly patient was diagnosed with HHNK after presenting with a blood sugar level of 800 mg/dL.


Often a result of inadequate insulin, causing the body to burn fat for energy.
His DKA was precipitated by insufficient insulin administration.


Management usually involves fluid resuscitation, insulin therapy, and careful electrolyte management.
Addressing the patient’s HHNK involved administering IV fluids, insulin, and closely monitoring electrolyte levels.


Can be triggered by stress, infection, or missed insulin doses.
Following a severe infection, she developed DKA due to the physiological stress.


Often triggered by stress, infection, or other acute illnesses, especially in those with impaired insulin action.
After suffering a stroke, the patient, with known insulin resistance, developed HHNK, complicating his clinical course.


Can DKA be life-threatening?

Yes, without prompt treatment, DKA can be fatal.

In which demographic is HHNK more common?

HHNK is often seen in older adults with Type 2 Diabetes.

What does DKA stand for?

Diabetic Ketoacidosis.

What does HHNK represent?

Hyperosmolar Hyperglycemic Nonketotic Syndrome.

Who is most likely to experience DKA?

Typically, individuals with Type 1 Diabetes.

What’s a characteristic symptom of HHNK?

Profound dehydration and occasionally altered mental status.

Can illnesses like pneumonia precipitate HHNK?

Yes, acute illnesses can indeed trigger HHNK.

What might trigger DKA in some individuals?

Missed insulin doses, infection, or severe stress.

Is it possible to prevent DKA and HHNK?

With proper management of diabetes and acute illnesses, the risk of DKA and HHNK can be minimized.

What might the blood sugar levels be in HHNK?

Extremely high, often exceeding 600 mg/dL.

What is a hallmark symptom of DKA?

Fruity-scented breath due to elevated ketones.

How urgently does DKA require treatment?

DKA is a medical emergency requiring immediate intervention.

Is immediate intervention crucial for HHNK?

Yes, HHNK is a medical emergency that requires immediate treatment.

Can DKA affect individuals with Type 2 Diabetes?

Yes, although less common, DKA can affect Type 2 Diabetics.

What is a key difference between DKA and HHNK?

DKA involves ketosis and acidosis, whereas HHNK does not.

Is HHNK characterized by ketosis?

No, HHNK typically does not involve significant ketosis.

How is DKA usually managed in a medical setting?

Through hydration, insulin therapy, and electrolyte management.

What are common management strategies for HHNK?

Fluid resuscitation, insulin administration, and monitoring of electrolytes.

Can DKA alter mental status?

Yes, severe DKA may lead to altered consciousness.

Is HHNK associated with a high mortality rate?

Yes, especially in those who are diagnosed late or inadequately treated.
About Author
Written by
Harlon Moss
Harlon is a seasoned quality moderator and accomplished content writer for Difference Wiki. An alumnus of the prestigious University of California, he earned his degree in Computer Science. Leveraging his academic background, Harlon brings a meticulous and informed perspective to his work, ensuring content accuracy and excellence.
Edited by
Janet White
Janet White has been an esteemed writer and blogger for Difference Wiki. Holding a Master's degree in Science and Medical Journalism from the prestigious Boston University, she has consistently demonstrated her expertise and passion for her field. When she's not immersed in her work, Janet relishes her time exercising, delving into a good book, and cherishing moments with friends and family.

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