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Diabetic hyperglycemic hyperosmolar syndrome

Contents of this page:

Illustrations

Food and insulin release
Food and insulin release

Alternative Names    Return to top

Hyperglycemic 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.

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