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