Hyperosmolar Hyperglycemic Nonketotic Syndrome

Hyperosmolar hyperglycemic nonketotic syndrome (HHNK) is a condition that usually occurs in older type 2 diabetics in whom severely elevated serum glucose results in an osmotic diuresis, electrolyte abnormalities, profound dehydration, and frequently AMS. HHNK is defined as a serum glucose >600 mg/dl, serum osmolarity > 320 to 330 mOsm/L, arterial pH >7.30, and negative or trace serum ketones. HHNK has an incidence roughly equivalent to DKA, and the two syndromes have significant overlap. HHNK differs from DKA in the more severely elevated glucose levels reached and the absence of ketoacidosis. Approximately half of patients with HHNK do not have a history of known diabetes. Many patients have precipitant medical or surgical conditions such as infection, MI, or stroke.

Causes

Some of the possible causes of Hyperglycemic Hyperosmolar Nonketotic Syndrome are such as includes in the list below: High blood sugars leading to the kidneys over filtering water, leading to excessive urination, leading to dehydration and few the possible causes infection, heart attack, kidney failure, medicines, illness, bleeding ulcer, blood clot and uncontrolled blood sugar

Symptoms

• Weakness ++++
• Polyuria ++++
• Polydipsia +++
• Anorexia +++
• Nausea and vomiting +++
• Dizziness ++
• Confusion

Signs

• Volume depletion +++++: dry oral mucosa, dry skin with poor turgor, orthostatic hypotension, and tachycardia (moderate to severe +++; mild ++)
• AMS: alert ++, lethargic +++, comatose +++. Mental status correlates with serum osmolarity; coma is rare below 350 mOsm/L.
• Seizures ++
• Altered mental status

Treatment

Treatments for Hyperglycemic Hyperosmolar Nonketotic Syndrome include:

• Extreme Hyperglycemic Hyperosmolar Nonketotic Syndrome requires gradual blood sugar lowering in a hospital setting. Milder Hyperglycemic Hyperosmolar Nonketotic Syndrome can be treated mainly by reducing blood sugars using insulin.
• Replacement of fluids is the fundamental need. This should be done cautiously in light of concerns in elderly patients of known or undiagnosed heart disease.
• Maintenance of electrolytes, such as potassium, is important.