Nonketotic Hyperosmolar Coma

Information about Nonketotic Hyperosmolar Coma

*Classification & external resources*
ICD-9	250.2
DiseasesDB	29213
eMedicine	emerg/264
MeSH	D006944

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). Other commonly used names are hyperosmolar hyperglycemic nonketotic coma (HHNKC)^[1] or hyperosmotic non-ketotic acidosis (HONK).

Pathophysiology

Nonketotic coma is usually precipitated by an acute illness, myocardial infarction or stroke. A relative insulin deficiency leads to a serum glucose that is usually higher than 33mmol/l (600 mg/dl), and a resulting serum osmolarity that is greater than 350 mOsm. This leads to polyuria (an osmotic diuresis), which, in turn, leads to volume depletion and hemoconcentration that causes a further increase in blood glucose level. Ketosis is absent because the presence of some insulin inhibits lipolysis, unlike diabetic ketoacidosis.

Clinical presentation

Diabetes mellitus
Types of Diabetes
Diabetes mellitus type 1 Diabetes mellitus type 2 Gestational diabetes Pre-diabetes: Impaired fasting glycaemia Impaired glucose tolerance
Disease Management
Diabetes management: •Diabetic diet •Anti-diabetic drugs •Conventional insulinotherapy •Intensive insulinotherapy
Other Concerns
Cardiovascular disease Diabetic comas: •Diabetic hypoglycemia •Diabetic ketoacidosis •Nonketotic hyperosmolar Diabetic myonecrosis Diabetic nephropathy Diabetic neuropathy Diabetic retinopathy Diabetes and pregnancy
Blood tests
Blood sugar Fructosamine Glucose tolerance test Glycosylated hemoglobin

The increasing hemoconcentration and volume depletion may result in:

Hyperviscosity and increased risk of thrombosis
Disturbed mentation
Neurologic signs including focal signs such as sensory or motor impairments or focal seizures or motor abnormalities, including flacidity, depressed reflexes, tremors or fasciculations.
Ultimately, if untreated, will lead to death.

Treatment

The treatment involves slow hydration, replacement of electrolytes and intravenous insulin. Anticoagulants (such as low molecular weight heparins) are often commenced as there is a significant rate of thrombosis in patients with NKHC. Mortality is 30% to 50%.

References

1. ^ Cirasino L, Thiella G, Invernizzi R, Silvani A, Ragaini S (1992). "Hyperosmolar hyperglycemic nonketotic coma in WaldenstrÃ¶m's macroglobulinemia associated with type II diabetes and complicated by pulmonary tuberculosis". Recenti progressi in medicina 83 (4): 194–6. PMID 1626111.

For other uses of "ICD", see ICD (disambiguation).

The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD
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The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. These codes are in the public domain.

External links

Diseases Database

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eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely, two medical doctors. It was sold to WebMD in January 2006.
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Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. Created and updated by the United States National Library of Medicine (NLM), it is used by the MEDLINE/PubMed
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Hyperglycemia
Classification & external resources

ICD-10 R73.9
ICD-9 790.6

Hyperglycemia, hyperglycaemia, or high blood sugar is a condition in which an excessive amount of glucose circulates in the blood plasma.
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Diabetic coma
Classification & external resources

ICD-10 E10.0, E11.0, E12.0, E13.0, E14.0
ICD-9 250.2 , 250.3

Diabetic coma is a medical emergency in which a person with diabetes mellitus is comatose (unconscious) because of one of the acute
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Diabetes mellitus type 2 (formerly called diabetes mellitus type II, non insulin-dependent diabetes (NIDDM), obesity related diabetes, or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency, and
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The American Diabetes Association, or the ADA, is an American health organization providing diabetes research, information and advocacy. Founded in 1940, the American Diabetes Association conducts programs in all 50 states and the District of Columbia, reaching hundreds of
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Glucose (Glc), a monosaccharide (or simple sugar), is an important carbohydrate in biology. The living cell uses it as a source of energy and metabolic intermediate.
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In chemistry, the osmole (Osm) is a non-SI unit of measurement that defines the number of moles of a chemical compound that contribute to a solution's osmotic pressure.
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Polyuria
Classifications and external resources

ICD-10 R 35.
ICD-9 788.42

Polyuria is the passage of a large volume of urine in a given period (>= 2.
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Ketosis (IPA pronunciation: [ki'tosɪs]) is a stage in metabolism occurring when the liver converts fat into fatty acids and ketone bodies which can be used by the body for energy. It was identified by Dr.
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''Note: This article title may be easily confused with inulin.

Insulin is an animal hormone whose presence informs the body's cells that the animal is well fed, causing liver and muscle cells to take in glucose and store it in the form of glycogen, and
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Lipolysis is the breakdown of fat stored in fat cells. During this process, free fatty acids are released into the bloodstream and circulate throughout the body. Ketones are produced, and are found in large quantities in ketosis (an adaptive metabolic state that occurs when
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Diabetic ketoacidosis (DKA) is a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia). Near complete deficiency of insulin and elevated levels of certain stress hormones combine to cause DKA.
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Diabetes mellitus
Classification & external resources

ICD-10 E 10. –E 14.
ICD-9 250

MedlinePlus 001214
eMedicine med/546 emerg/134

MeSH C18.452.394.
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Diabetes mellitus type 1
Classification & external resources

ICD-10 E10
ICD-9 250.x1, 250.x3

OMIM 222100
DiseasesDB 3649
MedlinePlus 000305
eMedicine med/546
MeSH D003922 Diabetes mellitus type 1
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Gestational diabetes
Classification & external resources

ICD-10 O 24.
ICD-9 648.8

MedlinePlus 000896

Gestational diabetes (GDM) is a form of diabetes which affects pregnant women who have never had diabetes before.
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Impaired fasting glycaemia (IFG) is a pre-diabetic state of dysglycemia, associated with insulin resistance and increased risk cardiovascular pathology, although of lesser risk than Impaired glucose tolerance (IGT).
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MeSH D018149 Impaired Glucose Tolerance (IGT) is a pre-diabetic state of dysglycemia, that is associated with insulin resistance and increased risk of cardiovascular pathology. IGT may precede type 2 diabetes mellitus by many years. IGT is also a risk factor for mortality.
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320 (7246): 1373–8. PMID 10818026.
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271 (18): 1421-8.
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Anti-diabetic drugs treat diabetes mellitus by lowering glucose levels in the blood. With the exceptions of insulin, exenatide, and pramlintide, all are administered orally and are thus also called oral hypoglycemic agents.
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Conventional insulinotherapy is a therapeutic regimen for treatment of diabetes mellitus which contrasts with the newer intensive insulinotherapy.

This older method (prior to the development of long-acting insulin analogs and blood glucose monitoring) is still in use in a
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Intensive insulinotherapy is a therapeutic regimen for diabetes mellitus treatment. This newer approach contrasts with conventional insulinotherapy. Rather than minimize the number of insulin injections per day (a technique which demands a rigid schedule for food and activities),
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MeSH D002318 Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). While the term technically refers to any disease that affects the cardiovascular system, it is usually used to refer to those related to
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Diabetic hypoglycemia
Classification & external resources

ICD-9 250.8

Diabetic hypoglycemia describes a low blood glucose level occurring in a person with diabetes mellitus.
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