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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.

Last reviewed December 2012 by Kim A. Carmichael, M.D., FACP

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.