Nonketotic hyperosmolar coma
From Wikipedia, the free encyclopedia
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).It is
also called Hyperglycaemic Hyperosmolar State(HHS),as some patients may have
some ketonuria and it does not necessarily cause coma.
Contents
[hide]
* 1 Pathophysiology
* 2 Clinical presentation
* 3 Treatment
* 4 References
[edit] Pathophysiology
Diabetes mellitus
Types of Diabetes
Diabetes mellitus type 1
Diabetes mellitus type 2
Gestational diabetes
Pre-diabetes:
Impaired fasting glycaemia
Impaired glucose tolerance
Disease Management
Diabetes management:
•Diabetic diet
•Anti-diabetic drugs
•Conventional insulinotherapy
•Intensive insulinotherapy
Other Concerns
Cardiovascular disease
Diabetic comas:
•Diabetic hypoglycemia
•Diabetic ketoacidosis
•Nonketotic hyperosmolar
Diabetic myonecrosis
Diabetic nephropathy
Diabetic neuropathy
Diabetic retinopathy
Diabetes and pregnancy
Blood tests
Blood sugar
Fructosamine
Glucose tolerance test
Glycosylated hemoglobin
Nonketotic coma is usually precipitated by an infection,[2] myocardial
infarction, stroke or another acute illness. A relative insulin deficiency leads
to a serum glucose that is usually higher than 33 mmol/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.
Clinical presentation
The increasing hemoconcentration and volume depletion may result in:
* Hyperviscosity and increased risk of thrombosis,
* Disordered mental functioning,
* 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
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.
References
1. ^ Cirasino L, Thiella G, Invernizzi R, Silvani A, Ragaini S (1992). "Hyperosmolar
hyperglycemic nonketotic coma in Waldenström's macroglobulinemia associated with
type II diabetes and complicated by pulmonary tuberculosis". Recenti progressi
in medicina 83 (4): 194–6. PMID 1626111.
2. ^ Stoner, GD (May 2005). "Hyperosmolar hyperglycemic state". American Family
Physician 71 (9): 1723–1730. PMID 15887451. http://www.aafp.org/afp/20050501/1723.html.
* This page was last modified on 17 November 2008, at 13:23.
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