Hyperosmolar Nonketotic Coma (HHNC, Hyperosmolar Coma, Diabetic Nonketotic Coma, Hyperosmolar Nonketotic State)

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Hyperosmolar nonketotic coma occurs in people with diabetes. This condition is life-threatening, so it is important to seek medical attention immediately if you think you have any symptoms of an impending hyperosmolar nonketotic coma.


Hyperosmolar nonketotic coma is a complication of hyperosmolar hyperglycemic nonketotic syndrome (HHNS), in which your body tries to get rid of excess blood glucose by passing it through your urine. When HHNS is severe, it can lead to seizures, coma, and eventually death.

Risk Factors

The following factors are thought to increase the risk of hyperosmolar nonketotic coma:


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2008 Nucleus Medical Art, Inc.


Symptoms that may occur before the onset of hyperosmolar nonketotic coma may include:

  • High blood glucose (over 600 milligrams per deciliter)
  • Dry mouth
  • Thirst
  • Warm, dry skin
  • Absence of sweating
  • Fever
  • Leg cramps
  • Sleepiness
  • Confusion
  • Vision loss
  • Hallucinations
  • Weakness on one side of the body
  • Frequent urination


If you arrive at the hospital in a hyperosmolar nonketotic coma, your vital signs will be monitored and you may receive the following tests:

Blood teststo test blood sugar, electrolytes, kidney functionChest x-raya test that uses radiation to take pictures of structures inside the body, especially bones Urine testsElectrocardiogram (ECG, EKG)a test that records the hearts activity by measuring electrical currents through the heart muscle EKG 2008 Nucleus Medical Art, Inc. TreatmentCommon treatments for hyperosmolar nonketotic coma include the following: Fluid and Mineral ReplacementFluids and minerals (potassium, sodium, chloride, phosphate, calcium, magnesium) will be given to you through an intravenous line to improve your urine output. InsulinTo help control your blood glucose levels, you will receive insulin through an IV. Treatment for Underlying CauseIf infection is the suspected cause, for example, then antibiotics will be administered. PreventionThe best way to prevent hyperosmolar nonketotic coma is to monitor your blood glucose levels regularly. Your doctor can instruct you about how often to check your levels, and what the numbers mean. Also, talk with your healthcare provider about how to manage your blood glucose when you are sick. RESOURCES: American Diabetes Associationhttp://www.diabetes.org/ National Diabetes Information Clearinghouse
http://diabetes.niddk.nih.gov/ CANADIAN RESOURCES: Canadian Diabetes Associationhttp://www.diabetes.ca/ Health Canadahttp://www.hc-sc.gc.ca/index_e.html References: Chiasson JL, Aris-Jilwan N, Belanger R, et al. Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Can Med Assoc J. 2003;168:859-866. Hyperosmolar hyperglycemic crisis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php .Accessed May 23, 2007. Kitabchi AE. Hyperglycemic crises in diabetes mellitus: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Endocrinol Metab Clin North Am. 2006;35:725-51 Stoner GD. Hyperosmolar hyperglycemic state. Am Fam Physician. 2005;71:1723-1730 What is hyperosmolar hyperglycemic nonketotic syndrome (HHNS)? American Diabetes Association website. Available at: http://www.diabetes.org/type-2-diabetes/treatment-conditions/hhns.jsp.Accessed May 23, 2007. Last reviewed May 2008 by David Juan, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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