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Hyperosmolar Nonketotic Coma

Definition

Hyperosmolar nonketotic coma occurs in people with diabetes. It is a life-threatening event. Seek medical attention immediately if you think you have any symptoms of an impending hyperosmolar nonketotic coma.

Causes

Hyperosmolar nonketotic coma is a complication of hyperosmolar hyperglycemic nonketotic syndrome (HHNS). HHNS happens when blood glucose levels rise, often with an illness or infection. Your body trys to get rid of excess blood glucose by passing it through your urine. It also washes out other substances that your body and brain need to function. When HHNS is severe, it can lead to seizures , coma, and eventually death.

Risk Factors
  • The following factors are thought to increase the risk of hyperosmolar nonketotic coma:
    • Older age
    • Diabetes and poorly monitored glucose levels
    • Infection
    • Drugs (eg, diuretics, steroids, anticonvulsant, chemotherapy drugs)
    • Disease states ( heart attack , stroke , kidney failure ,overactive thyroid gland )
    • Substance abuse
    • Recent operation
    • Stroke

    Symptoms
  • Symptoms that may occur before the onset of hyperosmolar nonketotic coma may include:
    • High blood glucose (over 600 milligrams per deciliter)
    • Dry mouth
    • Thirst
    • Warm, dry skin
    • Absence of sweating
    • Fever
    • Leg cramps
    • Sleepiness
    • Confusion
    • Vision loss
    • Hallucinations
    • Weakness or strange movements on one side of the body with or without seizures
    • Frequent urination
    Diagnosis

    If you arrive at the hospital in a hyperosmolar nonketotic coma, your vital signs will be monitored and you may receive the following tests:

    • Blood tests—to test blood sugar, electrolytes, kidney function
    • Chest x-ray
    • Urine tests
    • Electrocardiogram (ECG, EKG)—to check your heart's activity
    • EKG

    Treatment

    You will likely need treatment in the emergency room and/or the intensive care unit at the hospital. Common treatments for hyperosmolar nonketotic coma include the following:

    • Fluid and Mineral Replacement
    • Fluids and minerals (potassium, sodium, chloride, phosphate, calcium, magnesium) will be given to you through an IV. It will replace substance you lost and improve your urine output.
    • Insulin
    • Insulin will be given through an IV. It will help control your blood glucose levels.
    • Treatment for Underlying Cause
    • Antibiotics may be given if an infection is suspected.
    Prevention

    The best way to prevent hyperosmolar nonketotic coma is to monitor your blood glucose levels regularly. Your doctor can instruct you about how often to check your levels, and what the numbers mean. Also, talk with your doctor about how to manage your blood glucose when you are sick.

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