Diabetic coma Nonketotic hyperosmolar coma(patient information)

Nonketotic hyperosmolar coma
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Nonketotic hyperosmolar coma?
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief:; Assistant Editor(s)-In-Chief:

Overview

Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of type 2 diabetes that involves extremely high blood sugar (glucose) levels without the presence of ketones. Ketones are byproducts of fat breakdown.

What are the symptoms of Nonketotic hyperosmolar coma?

• Coma
• Confusion
• Convulsions
• Fever
• Increased thirst
• Increased urination (at the beginning of the syndrome)
• Lethargy
• Nausea
• Weakness
• Weight loss

Symptoms may get worse over a period of days or weeks.

Other symptoms that may occur with this disease:

• Dysfunctional movement
• Loss of feeling or function of muscles
• Speech impairment

What causes Nonketotic hyperosmolar coma?

Diabetic hyperglycemic hyperosmolar syndrome is a condition of:

• Extremely high blood sugar (glucose) levels
• Extreme lack of water (dehydration)
• Decreased consciousness

The buildup of ketones in the body (ketoacidosis) may also occur. However, it is unusual and often mild.

This condition is usually seen in people with type 2 diabetes. It may occur in those who have not been diagnosed with diabetes, or in people who have not been able to control their diabetes. The condition may be brought on by:

• Infection
• Other illness such as heart attack or stroke
• Medications that lower glucose tolerance or increase fluid loss (in people who are losing or not getting enough fluid)

Normally, the kidneys try to make up for high glucose levels in the blood by allowing the extra glucose to leave the body in the urine. If you do not drink enough fluids, or you drink fluids that contain sugar, the kidneys can no longer get rid of the extra glucose. Glucose levels in the blood can become very high as a result. The blood then becomes much more concentrated than normal (hyperosmolarity).

Hyperosmolarity is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances that normally cause water to move into the bloodstream. This draws the water out of the body's other organs, including the brain. Hyperosmolarity creates a cycle of increasing blood glucose levels and dehydration.

Who is at highest risk?

Risk factors include:

• A stressful event such as infection, heart attack, stroke, or recent surgery
• Congestive heart failure
• Impaired thirst
• Limited access to water (especially in patients with dementia or who are bedbound)
• Older age
• Poor kidney function
• Poor management of diabetes -- not following the treatment plan as directed
• Stopping insulin or other medications that lower glucose levels

Diagnosis

The doctor or nurse will examine you and ask questions about your symptoms and medical history. The exam may show that you have:

• Extreme dehydration
• Fever higher than 100.4 degrees Fahrenheit
• Increased heart rate
• Low systolic blood pressure

Test that may be done include:

• Blood osmolarity (concentration)
• BUN and creatinine levels
• Blood sodium level
• Ketone test
• Very high blood glucose

Evaluation for possible causes may include:

• Blood cultures
• Chest x-ray
• Electrocardiogram (ECG)
• Urinalysis

When to seek urgent medical care?

This condition is a medical emergency. Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of diabetic hyperglycemic hyperosmolar syndrome.

Treatment options

The goal of treatment is to correct the dehydration. This will improve the blood pressure, urine output, and circulation.

Fluids and potassium will be given through a vein (intravenously). High glucose levels are treated with insulin given through a vein.

Where to find medical care for Nonketotic hyperosmolar coma?

Directions to Hospitals Treating Nonketotic hyperosmolar coma

Prevention

Controlling type 2 diabetes and recognizing the early signs of dehydration and infection can help prevent this condition.

What to expect (Outlook/Prognosis)?

Patients who develop this syndrome are often already ill. The death rate with this condition is as high as 40%.

Possible complications

• Acute circulatory collapse (shock)
• Blood clot formation
• Brain swelling (cerebral edema)
• Increased blood acid levels (lactic acidosis)

Sources

http://www.nlm.nih.gov/medlineplus/ency/article/000304.htm

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