|
|
| (4 intermediate revisions by 3 users not shown) |
| Line 1: |
Line 1: |
| {{Infobox_Disease
| | #REDIRECT [[Hyperosmolar hyperglycemic state]] |
| | Name = {{PAGENAME}}
| |
| | Image =
| |
| | Caption =
| |
| | DiseasesDB = 29213
| |
| | ICD10 =
| |
| | ICD9 = {{ICD9|250.2}}
| |
| | ICDO =
| |
| | OMIM =
| |
| | MedlinePlus =
| |
| | eMedicineSubj = emerg
| |
| | eMedicineTopic = 264
| |
| | MeshID = D006944
| |
| }}
| |
| {{SI}}
| |
| | |
| {{CMG}}
| |
| | |
| {{EH}}
| |
| | |
| '''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)<ref name="pmid1626111">{{cite journal |author=Cirasino L, Thiella G, Invernizzi R, Silvani A, Ragaini S |title=Hyperosmolar hyperglycemic nonketotic coma in Waldenström's macroglobulinemia associated with type II diabetes and complicated by pulmonary tuberculosis |journal=Recenti progressi in medicina |volume=83 |issue=4 |pages=194–6 |year=1992 |pmid=1626111 |doi=}}</ref> 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}}
| |
| 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]]. [[Anticoagulant]]s (such as [[low molecular weight heparin]]s) are often commenced as there is a significant rate of [[thrombosis]] in patients with NKHC.
| |
| | |
| ==References==
| |
| <references/>
| |
| {{SIB}}
| |
| [[Category:Medical emergencies]]
| |
| [[Category:Diabetes]]
| |
| [[Category:Emergency medicine]]
| |
| [[Category:Neurology]]
| |
| | |
| {{WH}}
| |
| {{WikiDoc Sources}}
| |