Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of
Hyperglycemic hyperosmolar coma; Nonketotic hyperglycemic hyperosmolar coma (NKHHC); Hyperosmolar nonketotic coma (HONK)
Causes, incidence, and risk factors
Diabetic hyperglycemic hyperosmolar syndrome is a condition of:
Extremely high blood sugar (glucose) levels
Extreme lack of water (
The buildup of ketones in the body (
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:
Other illness such as heart attack or stroke
Medications that lower glucose tolerance or increase fluid loss (in people who are losing or not getting enough fluid)
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:
A stressful event such as infection,
heart attack, stroke, or recent surgery Congestive heart failure
- Impaired thirst
- Limited access to water (especially in patients with
dementiaor who are bedbound)
Poor kidney function
Poor management of diabetes — not following the treatment plan as directed
Stopping insulin or other medications that lower glucose levels
- Increased urination (at the beginning of the syndrome)
- Weight loss
Symptoms may get worse over a period of days or weeks.
Other symptoms that may occur with this disease:
- Dysfunctional movement
- Loss of feeling or function of muscles
- Speech impairment
Signs and tests
The doctor or nurse will examine you and ask questions about your symptoms and medical history. The exam may show that you have:
- Fever higher than 100.4 degrees Fahrenheit
- Low systolic blood pressure
Test that may be done include:
- Blood osmolarity (concentration)
- Ketone test
- Very high
Evaluation for possible causes may include:
Blood cultures Chest x-ray Electrocardiogram(ECG) Urinalysis
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 (
Patients who develop this syndrome are often already ill. The death rate with this condition is as high as 40%.
Acutecirculatory collapse ( shock)
- Blood clot formation
- Brain swelling (cerebral edema)
- Increased blood acid levels (
Calling your health care provider
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.
Controlling type 2 diabetes and recognizing the early signs of dehydration and infection can help prevent this condition.
Related:Diabetes – what to ask your doctor – type 2, Alertness – decreased, Dehydration, Glucose test – blood, Diabetic Ketoacidosis, Type 2 Diabetes, Heart Failure Overview, Heart attack, Stroke, Acute, Lactic acidosis