Definition, Etiology, and Precipitating Factors of Hyperosmolar Hyperglycemic Non-Ketotic Coma

In this article, we will discuss the Definition, Etiology, and Precipitating Factors of Hyperosmolar Hyperglycemic Non-Ketotic Coma. So, let’s get started.

Definition

Hyperosmolar Hyperglycemic Non-Ketotic Coma (HHNKC) is an acute metabolic decompensation of the diabetic state in type 2 diabetes, characterized by extreme hyperglycemia (blood glucose> 600 mg/dl) and increased osmolality (> 320 mOsm/kg) with dehydration without significant ketosis or acidosis.

Etiology

The patients of type 2 diabetes mellitus are prone to develop hyperosmolar hyperglycemic non-ketotic coma and it includes:

1. Type 2 diabetes detected for the first time (undiagnosed diabetics)

2. Middle aged or older diabetics (>50 years of age)

3. Those living alone

4. Those with no access to medical treatment

5. Those with associated infection or stroke

Precipitating Factors

Acute infections, burns, trauma

Vascular episode (CVA or AMI)

Excessive alcohol consumption

Hyperalimentation

Drugs, e.g. thiazides, steroids, phenytoin, chlorpromazine, diazoxide, immunosuppressive, sympathomimetics, beta-blockers, calcium channel blockers, etc

Recurrent vomiting

Dialysis (peritoneal or hemodialysis) in a patient with uremia

Use of osmotic agents (e.g. mannitol)

Recent surgery

Heart failure

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