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| {{Infobox_Disease
| | #REDIRECT [[Hyperosmolar hyperglycemic state]] |
| | Name = {{PAGENAME}}
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| | Image =
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| | Caption =
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| | DiseasesDB = 29213
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| | ICD10 =
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| | ICD9 = {{ICD9|250.2}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus =
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| | eMedicineSubj = emerg
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| | eMedicineTopic = 264
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| | MeshID = D006944
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| }}
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| {{SI}}
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| {{CMG}}
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| {{EH}}
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| ==Overview==
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| '''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)<ref name="pmid1626111">{{cite journal |author=Cirasino L, Thiella G, Invernizzi R, Silvani A, Ragaini S |title=Hyperosmolar hyperglycemic nonketotic coma in Waldenström's macroglobulinemia associated with type II diabetes and complicated by pulmonary tuberculosis |journal=Recenti progressi in medicina |volume=83 |issue=4 |pages=194–6 |year=1992 |pmid=1626111 |doi=}}</ref> or hyperosmotic non-ketotic acidosis (HONK).
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| ==Pathophysiology==
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| Nonketotic coma is usually precipitated by an acute illness, myocardial infarction or stroke. A relative insulin deficiency leads to a serum [[glucose]] that is usually higher than 33mmol/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]].
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| ==Clinical presentation==
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| {{Diabetes}}
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| The increasing hemoconcentration and volume depletion may result in:
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| * Hyperviscosity and increased risk of thrombosis
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| * Disturbed mentation
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| * Neurologic signs including focal signs such as sensory or motor impairments or focal seizures or motor abnormalities, including flacidity, depressed reflexes, tremors or fasciculations.
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| * Ultimately, if untreated, will lead to death.
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| ==Treatment==
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| The treatment involves slow hydration, replacement of electrolytes and intravenous [[insulin]]. [[Anticoagulant]]s (such as [[low molecular weight heparin]]s) are often commenced as there is a significant rate of [[thrombosis]] in patients with NKHC.
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| ==References==
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| <references/>
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| {{SIB}}
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| [[Category:Medical emergencies]]
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| [[Category:Diabetes]]
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| [[Category:Emergency medicine]]
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| [[Category:Neurology]]
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| {{WH}}
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| {{WikiDoc Sources}}
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