Diabetic coma nonketotic hyperosmolar coma: Difference between revisions
Rim Halaby (talk | contribs) Created page with "__NOTOC__ Please help WikiDoc by adding content here. It's easy! Click here to learn about editing. {{Diabetic coma}} {{CMG}} {{SK}} Hypergly..." |
m Bot: Removing from Primary care |
||
| Line 28: | Line 28: | ||
{{WH}} | {{WH}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
| Line 36: | Line 37: | ||
[[Category:Medical conditions related to obesity]] | [[Category:Medical conditions related to obesity]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
Latest revision as of 21:20, 29 July 2020
Please help WikiDoc by adding content here. It's easy! Click here to learn about editing.
|
Diabetic coma Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Diabetic coma nonketotic hyperosmolar coma On the Web |
|
American Roentgen Ray Society Images of Diabetic coma nonketotic hyperosmolar coma |
|
Risk calculators and risk factors for Diabetic coma nonketotic hyperosmolar coma |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Hyperglycemic hyperosmolar coma; nonketotic hyperglycemic hyperosmolar coma; NKHHC; hyperosmolar nonketotic coma; HONK
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.