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Hyperosmolar Nonketotic Coma

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

Definition

Hyperosmolar nonketotic coma occurs in people with diabetes. It is a life-threatening event. 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). HHNS happens when blood glucose levels rise, often with an illness or infection. Your body trys to get rid of excess blood glucose by passing it through your urine. It also washes out other substances that your body and brain need to function. 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 or strange movements on one side of the body with or without seizures
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
Urine tests
Electrocardiogram (ECG, EKG)—to check your heart's activity

EKG

Treatment

You will likely need treatment in the emergency room and/or the intensive care unit at the hospital. 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 IV. It will replace substance you lost and improve your urine output.

Insulin

Insulin will be given through an IV. It will help control your blood glucose levels.

Treatment for Underlying Cause

Antibiotics may be given if an infection is suspected.

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 doctor 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/

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 . Updated August 2, 2012. Accessed December 31, 2012.

Kim DW, Moon Y, Gee Noh H, Choi JW, Oh J. Blood-brain barrier disruption is involved in seizure and hemianopsia in nonketotic hyperglycemia. Neurologist . 2011 May;17(3):164-166.

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

Ondo WG. Hyperglycemic nonketotic states and other metabolic imbalances. Handb Clin Neurol . 2011;100:287-291.

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 December 31, 2012.

Revision Information

Reviewer: Kim A. Carmichael, M.D., FACP
Review Date: 12/2012 -
Update Date: 12/31/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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