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). Another commonly used name is hyperosmolar hyperglycemic nonketotic coma (HHNKC).
| Diabetes mellitus
|
|---|
| Types of Diabetes |
| Diabetes mellitus type 1 Diabetes mellitus type 2 Gestational diabetes Pre-diabetes: |
| Disease Management |
| Diabetes management: •Diabetic diet •Anti-diabetic drugs •Conventional insulinotherapy •Intensive insulinotherapy |
| Other Concerns |
| Cardiovascular disease
Diabetic comas: Diabetic myonecrosis |
| Blood tests |
| Fructosamine Glucose tolerance test Glycosylated hemoglobin |
[edit] Pathophysiology
Nonketotic coma is usually precipitated by an acute illness. The serum glucose is usually higher than 600 mg/dl, and the resulting serum osmolarity is greater than 350 mOsm. Ketosis is absent because the presence of insulin inhibits lipolysis, unlike diabetic ketoacidosis.
[edit] Treatment
The treatment involves slow hydration and insulin. Anticoagulants (such as low molecular weight heparins) are often commenced as there is a significant rate of thrombosis in patients with NKHC.
