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Diabetic hyperglycemic hyperosmolar comaDefinitionDiabetic hyperglycemic hyperosmolar coma is a complication of type 2 diabetes that involves extremely high blood sugar (glucose) levels without the presence of ketones. Ketones are a by-product of fat breakdown. Alternative NamesNonketotic hyperglycemic hyperosmolar coma; NKHHC; HONK - hyperosmolar non-ketotic comaCausesThis 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 with diet and medications. The condition may be brought on by an infection, or by certain medications that lower glucose tolerance or increase fluid loss. Normally, the kidneys make up for high glucose levels in the blood by allowing the extra glucose to leave the body in the urine. However, when water is scarce, the kidneys conserve (save) fluid, and glucose levels become higher. This results in a greater need for water. Hyperosmolarity is a condition in which the blood has a high concentration of sodium, glucose, and other substances that normally cause water to move into the bloodstream. When the kidneys are conserving water, however, this creates a cycle of increasing blood-glucose levels and dehydration. Risk factors include:
Symptoms
Symptoms may get worse over a period of days or weeks. Other symptoms that may occur with this disease:
Exams and TestsSigns may include:
Tests results include:
Evaluation for possible causes may include: TreatmentThe 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 intravenous insulin. Outlook (Prognosis)The death rate with this condition is as high as 40%. Possible Complications
When to Contact a Medical ProfessionalThis 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 coma. PreventionControlling type 2 diabetes and recognizing the early signs of dehydration and infection can help prevent this condition. ReferencesCydulka RK, Pennington J. Diabetes Mellitus and Disorders of Glucose Homeostasis. In: Marx JA, Hockberger RS, Walls RM, Adams JG. Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa:Mosby, Inc.;2006:chap 124.
Review Date:
8/8/2006 Reviewed By: Robert Hurd, MD, Department of Biology, College of Arts and Sciences, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-
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