Advertisements
Advertisements

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

Advertisements
Advertisements

Common Causes of Coma

In this article, we will discuss some of the Common Causes of Coma. So, let’s get started.

Causes

A. Brainstem and Cerebellar lesions

  • Infarction, hemorrhage of brainstem and cerebellum
  • Tumor, trauma
B. Lesions of cerebral hemisphere with edema and brainstem compression
  • Infarction, hemorrhage
  • Encephalitis, meningitis, brain abscess
  • Tumor, trauma (subdural, extradural)
  • Hydrocephalus
  • Hypertensive encephalopathy
  • Status epilepticus
  • Cerebral malaria
C. Metabolic abnormalities
  • Diabetic and hypoglycemic coma
  • Hepatic failure, renal failure, cardiac failure, respiratory failure
  • Severe hyponatremia or hypokalemia
  • Hyper and hypocalcaemia
  • Hypoxia
  • Myxoedema coma, hypopituitarism
  • Adrenal crisis
  • Vitamin deficiencies (e.g. B1, nicotinic acid, B12)
D. Drugs and physical agents
  • Anaesthetic agents
  • Drug overdose or poisoning and alcohol ingestion
  • Hyper and hypothermia
E. Psychogenic/hysteria

Definition of Coma

In this article, we will discuss the Definition of Coma. So, let’s get started.

Definition

Coma is defined as a persistent loss of consciousness in which the subject lies with eyes closed and shows no understandable response to an external stimulus or inner need. The coma may vary in degree; and in deep coma, i.e. corneal, pupillary, pharyngeal reflexes are lost. The tendon and plantar reflexes also become absent. With lesser degree of coma (precoma), pupillary reflexes, reflex ocular movements and other brainstem reflexes are preserved and there may or may not be rigidity of the limbs and extensor plantar response.

The term coma refers to a deep sleep-like state from which the patient cannot be aroused. The stupor refers to a sleep-like state from which the patient can be aroused with vigorous stimuli and the patient tries to avoid the stimuli. Drowsiness means light sleep-like state from which patients can easily arouse and there is a brief period of alertness.

%d bloggers like this: