Hyperosmolar nonketotic coma occurs in people with
diabetes, usually type 2. It is a life-threatening event. Seek medical attention right away if you think you have any symptoms of an impending hyperosmolar nonketotic coma.
Hyperosmolar nonketotic coma is a
of very high blood glucose levels. Blood glucose often rises to these levels because of an illness or infection.
The body will try to get rid of the extra blood glucose through the urine. The frequency and volume of urination will increase. Unfortunately, this process also washes out other substances in your blood. Some of these substances are important to your brain and heart. Low levels of these substances can lead to
coma, and eventually death.
Hyperosmolar nonketotic coma can happen at any age in patients with diabetes, but is most commonly see in older adults and patients with type 2 diabetes.
Other factors that may increase your chance of hyperosmolar nonketotic coma include:
Poorly monitored glucose levels
Taking certain medications, such as diuretics, steroids, anticonvulsants,
Treatment will be needed in the emergency room and/or the intensive care unit at the
Treatment will focus on hydration and restoring the correct balance of substances in the blood, including glucose. Treatment may include:
Fluids and minerals through an IV
Improves hydration and replaces lost substances.
Will also help get rid of excess glucose in the urine
Insulin through an IV
Usually started right away in adults to control blood glucose levels.
Will be started in children after IV fluids have rehydrated them and some excess glucose has been voided
Additional treatment, such as antibiotics, may be needed if a bacterial infection is suspected.
To help prevent hyperosmolar nonketotic coma:
Monitor your blood glucose levels regularly. Your doctor can instruct you about how often to check your levels, and what the numbers mean.
Drink plenty of fluids throughout the day.
Talk with your doctor about how to manage your blood glucose when you are sick.
Hyperosmolar hyperglycemic nonketotic syndrome (HHNS). American Diabetes Association website. Available at: http://www.diabetes.org/living-with-diabetes/complications/hyperosmolar-hyperglycemic.html. Updated December 6, 2013. Accessed August 24, 2017.
Wolfsdorf J, et al. ISPAD Clinical Practice Consensus Guidelines 2014. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2014 Sep;15 Suppl 20:154-79.
Zeitler P, et al. Hyperglycemic hyperosmolar syndrome in children: pathophysiological considerations and suggested guidelines for treatment. J Pediatr. 2011 Jan;158(1):9-14.https://www.pedsendo.org/education_training/healthcare_providers/consensus_statements/assets/hyperosmolar.pdf
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