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Alternative names Return to top
Nonketotic hyperglycemic coma; NKHHC; HONK - hyperosmolar non-ketotic comaDefinition Return to top
Diabetic hyperglycemic hyperosmolar coma is a complication of type 2 diabetes that results in extremely high glucose levels without the presence of ketones (a by-product of fat that can cause other complications).Causes, incidence, and risk factors Return to top
Diabetic hyperglycemic hyperosmolar coma is a condition of decreased consciousness, extreme dehydration (lack of water), and extremely high blood glucose (sugar) levels, which is not accompanied by ketoacidosis.
The condition is usually seen in people with non-insulin-dependent diabetes (type 2 diabetes) and may occur in those previously undiagnosed with diabetes or in those who have improperly managed their medications and diet. The condition may be brought on by an infection or by certain medications that impair glucose tolerance or increase fluid loss.
Normally, the kidneys compensate for high glucose levels in the blood by excreting excess glucose in the urine. However, when water is scarce, the kidneys conserve fluid, and glucose levels become higher. This results in greater need for water.
Hyperosmolarity is a condition in which the blood is concentrated with sodium, glucose, and other molecules that normally attract water into the bloodstream. When the kidneys are conserving water, however, this creates a vicious cycle of increasing blood-glucose levels and increasing dehydration.
Risk factors include:
Symptoms Return to top
The onset of symptoms may be over a period of days or weeks.Signs and tests Return to top
Vital signs (temperature, pulse, rate of breathing, blood pressure):
Treatment Return to top
The goal of treatment is to correct the dehydration, which will improve the blood pressure, urine output, and poor circulation. Fluids and potassium are replaced by intravenous therapy. High glucose levels are treated with intravenous insulin.Expectations (prognosis) Return to top
The death rate associated with this condition is as much as 40%.Complications Return to top
Calling your health care provider Return to top
This condition is a MEDICAL EMERGENCY! Go to the emergency room or call the local emergency number (such as 911) if signs or symptoms of diabetic hyperglycemic hyperosmolar coma develop.Prevention Return to top
Good control of type 2 diabetes, coupled with recognition of early signs of dehydration and infection, can help prevent this condition. Update Date: 8/6/2004 Updated by: Aniket R. Sidhaye, M.D., Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network.
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Page last updated: 28 October 2004 |