Diabetic Hyperglycemic Hyperosmolar Coma - Complication...

Diabetic Hyperglycemic Hyperosmolar Coma

Diabetic Hyperglycemic Hyperosmolar Coma

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 by-products of fat breakdown.
Reference from A.D.A.M.
Back to TopAlternative Names
Hyperglycemic hypersmolar coma; Nonketotic hyperglycemic hyperosmolar coma (NKHHC); Hyperosmolar non-ketotic coma (HONK)

Causes
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.

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
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.

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

Symptoms
Coma
Confusion
Convulsions
Increased thirst
Increased urination (at the beginning of the syndrome)
Lethargy
Nausea
Weakness
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

Exams and Tests
Signs may include:

Extreme dehydration
High temperature -- higher than 38 degrees Centigrade (100.4 degrees Fahrenheit)
Increased heart rate
Low systolic blood pressure
Test results include:

High serum osmolarity (concentration)
Higher than normal BUN and creatinine
Higher than normal serum sodium
Mild ketone buildup (ketosis)
Very high blood glucose
Evaluation for possible causes may include:

Blood cultures
Chest x-ray
Electrocardiogram (ECG)
Urinalysis

Treatment
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 intravenous insulin.

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)

When to Contact a Medical Professional
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.

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