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| Nonketotic hyperosmolar coma Classification and external resources |
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| ICD-9 | 250.2 |
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| DiseasesDB | 29213 |
| eMedicine | emerg/264 |
| MeSH | D006944 |
Nonketotic hyperosmolar coma (nonketotic hyperglycaemia) is a type of diabetic coma associated with a high mortality seen in diabetes mellitus type 2. The preferred term used by the American Diabetes Association is hyperosmolar nonketotic state (HNS). Other commonly used names are hyperosmolar hyperglycemic nonketotic coma (HHNKC)1 or hyperosmotic non-ketotic acidosis (HONK).It is also called Hyperglycaemic Hyperosmolar State(HHS),as some patients may have some ketonuria and it does not necessarily cause coma.
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Pathophysiology
| Diabetes mellitus
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| Types of Diabetes |
| Diabetes mellitus type 1 Diabetes mellitus type 2 Gestational diabetes Pre-diabetes: |
| Disease Management |
| Diabetes management: •Diabetic diet •Anti-diabetic drugs •Conventional insulinotherapy •Intensive insulinotherapy |
| Other Concerns |
| Cardiovascular disease
Diabetic comas: Diabetic myonecrosis |
| Blood tests |
| Blood sugar Fructosamine Glucose tolerance test Glycosylated hemoglobin |
Nonketotic coma is usually precipitated by an infection,2 myocardial infarction, stroke or another acute illness. A relative insulin deficiency leads to a serum glucose that is usually higher than 33 mmol/l (600 mg/dl), and a resulting serum osmolarity that is greater than 350 mOsm. This leads to polyuria (an osmotic diuresis), which, in turn, leads to volume depletion and hemoconcentration that causes a further increase in blood glucose level. Ketosis is absent because the presence of some insulin inhibits lipolysis, unlike diabetic ketoacidosis.
Clinical presentation
The increasing hemoconcentration and volume depletion may result in:
- Hyperviscosity and increased risk of thrombosis,
- Disordered mental functioning,
- Neurologic signs including focal signs such as sensory or motor impairments or focal seizures or motor abnormalities, including flacidity, depressed reflexes, tremors or fasciculations,
- Ultimately, if untreated, will lead to death.
Treatment
The treatment involves slow hydration, replacement of electrolytes and intravenous insulin. Anticoagulants (such as low molecular weight heparins) are often commenced as there is a significant rate of thrombosis in patients with NKHC.
References
- ^ Cirasino L, Thiella G, Invernizzi R, Silvani A, Ragaini S (1992). "Hyperosmolar hyperglycemic nonketotic coma in Waldenström's macroglobulinemia associated with type II diabetes and complicated by pulmonary tuberculosis". Recenti progressi in medicina 83 (4): 194–6. PMID 1626111.
- ^ Stoner, GD (May 2005). "Hyperosmolar hyperglycemic state". American Family Physician 71 (9): 1723–1730. PMID 15887451, http://www.aafp.org/afp/20050501/1723.html.
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