Hyperosmolar Nonketotic Coma

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

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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

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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:

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.