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Alternative Names Return to top
Nonketotic hyperglycemic hyperosmolar coma; NKHHC; HONK - hyperosmolar non-ketotic comaDefinition Return to top
Diabetic hyperglycemic hyperosmolar coma is a complication of type 2 diabetes that involves extremely high blood sugar (glucose) levels without the presence of ketones. Ketones are a by-product of fat breakdown.
Causes Return to top
This condition is usually seen in people with type 2 diabetes. It may occur in those who have not been diagnosed with diabetes, or in people who have not been able to control their diabetes with diet and medications.
The condition may be brought on by an infection, or by certain medications that lower glucose tolerance or increase fluid loss.
Normally, the kidneys make up for high glucose levels in the blood by allowing the extra glucose to leave the body in the urine. However, when water is scarce, the kidneys conserve (save) fluid, and glucose levels become higher. This results in a greater need for water.
Hyperosmolarity is a condition in which the blood has a high concentration of sodium, glucose, and other substances that normally cause water to move into the bloodstream. When the kidneys are conserving water, however, this creates a cycle of increasing blood-glucose levels and dehydration.
Risk factors include:
Symptoms Return to top
Symptoms may get worse over a period of days or weeks.
Other symptoms that may occur with this disease:
Exams and Tests Return to top
Signs may include:
Tests results include:
Evaluation for possible causes may include:
Treatment Return to top
The goal of treatment is to correct the dehydration. This will improve the blood pressure, urine output, and circulation.
Fluids and potassium will be given through a vein (intravenously). High glucose levels are treated with intravenous insulin.
Outlook (Prognosis) Return to top
The death rate with this condition is as high as 40%.
Possible Complications Return to top
When to Contact a Medical Professional Return to top
This condition is a medical emergency. Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of diabetic hyperglycemic hyperosmolar coma.
Prevention Return to top
Controlling type 2 diabetes and recognizing the early signs of dehydration and infection can help prevent this condition.
References Return to top
Cydulka RK, Pennington J. Diabetes Mellitus and Disorders of Glucose Homeostasis. In: Marx JA, Hockberger RS, Walls RM, Adams JG. Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa:Mosby, Inc.;2006:chap 124.
Update Date: 8/8/2006 Updated by: Robert Hurd, MD, Department of Biology, College of Arts and Sciences, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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Page last updated: 25 September 2008 |