Nonketotic hyperosmolar coma: Difference between revisions
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==Overview== | ==Overview== | ||
'''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). | '''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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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]]. | 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]]. | ||
== | ==Diagnosis== | ||
===History and Symptoms=== | |||
The increasing hemoconcentration and volume depletion may result in: | The increasing hemoconcentration and volume depletion may result in: | ||
* Hyperviscosity and increased risk of thrombosis | * Hyperviscosity and increased risk of thrombosis | ||
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==Treatment== | ==Treatment== | ||
===Medical Therapy=== | |||
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. | 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. | ||
==References== | ==References== | ||
{{reflist|2}} | |||
{{WH}} | {{WH}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Revision as of 17:25, 21 February 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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).
Pathophysiology
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.
Diagnosis
History and Symptoms
The increasing hemoconcentration and volume depletion may result in:
- Hyperviscosity and increased risk of thrombosis
- Disturbed mentation
- 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
Medical Therapy
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.