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Diabetic hyperglycemic hyperosmolar coma
Alternative namesNonketotic hyperglycemic coma; NKHHC; HONK - hyperosmolar non-ketotic coma
DefinitionDiabetic 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 , which can cause other complications).
Causes, incidence, and risk factors
Diabetic hyperglycemic hyperosmolar coma is a condition characterized by 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 and may occur in those previously undiagnosed with diabetes or in those who have improperly managed their medications and diet. The condition may be precipitated by an infection or by certain medications that impair glucose tolerance or increase fluid loss.
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 are older age; underlying kidney insufficiency; congestive heart failure ; recent discontinuation of insulin or oral hypoglycemic agents; improper management of diabetes; and a precipitating event such as infection, heart attack , stroke , or recent surgery.
Additional symptoms that may be associated with this disease:
Signs and tests
Vital signs (temperature, pulse , rate of breathing, blood pressure ):
TreatmentThe 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)The death rate associated with this condition is up to 40%.
Calling your health care providerThis 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.
PreventionGood control of type 2 diabetes , coupled with recognition of early signs of dehydration and infection, can help prevent this condition.
Update Date: 7/26/2002Todd T. Brown, M.D., Division of Endocrinology and Metabolism, Johns Hopkins Hospital, Baltimore, MD. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT