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Alternative Names Return to topHyperglycemic hyperosmolar coma; Nonketotic hyperglycemic hyperosmolar coma (NKHHC); Hyperosmolar nonketotic coma (HONK)
Definition Return to top
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 byproducts of fat breakdown.
Causes Return to top
Diabetic hyperglycemic hyperosmolar syndrome is a condition of:
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:
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:
Symptoms Return to top
Symptoms may get worse over a period of days or weeks.
Other symptoms that may occur with this disease:
Exams and Tests Return to top
Signs may include:
Test results include:
Evaluation for possible causes may include:
Treatment Return to top
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) Return to top
Patients who develop this syndrome are often already ill. The death rate with this condition is as high as 40%.
Possible Complications Return to top
When to Contact a Medical Professional Return to top
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 Return to top
Controlling type 2 diabetes and recognizing the early signs of dehydration and infection can help prevent this condition.
References Return to top
Kitabchi AE, Umpierrez GE, Murphy MB, Kreisberg RA. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2006;29:2739-2748.Update Date: 10/6/2008 Updated by: Deborah Wexler, MD, Assistant Professor of Medicine, Harvard Medical School, Endocrinologist, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.