Your Health - Hyperosmolar Nonketotic Coma

Hyperosmolar Nonketotic Coma

(HHNC; Hyperosmolar Coma; Diabetic Nonketotic Coma; Hyperosmolar Nonketotic State)

Definition

Hyperosmolar nonketotic coma occurs in people with diabetes . This condition is life-threatening, so it is important to seek medical attention immediately if you think you have any symptoms of an impending hyperosmolar nonketotic coma.

Causes

Hyperosmolar nonketotic coma is a complication of hyperosmolar hyperglycemic nonketotic syndrome (HHNS), in which your body tries to get rid of excess blood glucose by passing it through your urine. When HHNS is severe, it can lead to seizures , coma , and eventually death.

Risk Factors

The following factors are thought to increase the risk of hyperosmolar nonketotic coma:

Older age
Diabetes and poorly monitored glucose levels
Infection
Drugs (eg, diuretics, steroids, anticonvulsant, chemotherapy drugs)
Disease states ( heart attack , stroke , kidney failure , overactive thyroid gland )
Substance abuse
Recent operation

Stroke

Symptoms

Symptoms that may occur before the onset of hyperosmolar nonketotic coma may include:

High blood glucose (over 600 milligrams per deciliter)
Dry mouth
Thirst
Warm, dry skin
Absence of sweating
Fever
Leg cramps
Sleepiness
Confusion
Vision loss
Hallucinations
Weakness on one side of the body
Frequent urination

Diagnosis

If you arrive at the hospital in a hyperosmolar nonketotic coma, your vital signs will be monitored and you may receive the following tests:

Blood tests—to test blood sugar, electrolytes, kidney function
Chest x-ray —a test that uses radiation to take pictures of structures inside the body, especially bones
Urine tests
Electrocardiogram (ECG, EKG) —a test that records the heart’s activity by measuring electrical currents through the heart muscle

EKG

Treatment

Common treatments for hyperosmolar nonketotic coma include the following:

Fluid and Mineral Replacement

Fluids and minerals (potassium, sodium, chloride, phosphate, calcium, magnesium) will be given to you through an intravenous line to improve your urine output.

Insulin

To help control your blood glucose levels, you will receive insulin through an IV.

Treatment for Underlying Cause

If infection is the suspected cause, for example, then antibiotics will be administered.

Prevention

The best way to prevent hyperosmolar nonketotic coma is to monitor your blood glucose levels regularly. Your doctor can instruct you about how often to check your levels, and what the numbers mean. Also, talk with your healthcare provider about how to manage your blood glucose when you are sick.

RESOURCES:

American Diabetes Association
http://www.diabetes.org/

National Diabetes Information Clearinghouse
http://diabetes.niddk.nih.gov/

CANADIAN RESOURCES:

Canadian Diabetes Association
http://www.diabetes.ca/

Health Canada
http://www.hc-sc.gc.ca/index_e.html

References:

Chiasson JL, Aris-Jilwan N, Belanger R, et al. Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Can Med Assoc J. 2003;168:859-866.

Hyperosmolar hyperglycemic crisis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Accessed May 23, 2007.

Kitabchi AE. Hyperglycemic crises in diabetes mellitus: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Endocrinol Metab Clin North Am. 2006;35:725-51

Stoner GD. Hyperosmolar hyperglycemic state. Am Fam Physician. 2005;71:1723-1730

What is hyperosmolar hyperglycemic nonketotic syndrome (HHNS)? American Diabetes Association website. Available at: http://www.diabetes.org/type-2-diabetes/treatment-conditions/hhns.jsp . Accessed May 23, 2007.

Last reviewed September 2009 by Bridget Sinnott, MD, FACE

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.