Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is a potentially deadly condition that can develop as a result of infection or illness in people with uncontrolled type2 diabetesor when diabetes medications aren’t taken as directed. Some also refer to this as a “diabetic coma.”
HHNS is a relatively rare complication of diabetes, accounting for just 1% of hospital admissions among people with diabetes.
The symptoms of HHNS may appear slowly, taking days or even weeks to fully develop. Common symptoms include:
If you have symptoms of extreme thirst, frequent urination, confusion, and blurry vision, it’s important that you seek medical care immediately, as you could be experiencing symptoms of hyperglycemia, which may be life-threatening.
Ellen Lindner / Verywell
HHNS develops whenglucose levels surge(typically above 600 mg/dL), leading to severe dehydration. This dehydration occurs because elevated levels of glucose cause blood to become thicker and result in the body needing to produce more urine in order to lower them.
The result is frequent urination, which can result in serious or even life-threatening dehydration. If these fluids are not adequately replenished, the condition may eventually result in a seizure, coma, or even death.
The condition is more likely to affect older adults, and especially those of African-American, Native American, or Hispanic ethnic backgrounds. Rarely, HHNS can occur in people who have not yet been diagnosed with diabetes.
A blood glucose level of 600 mg/dL and lowketone levelsare the main factors for the diagnosis of HHNS.
How Hyperglycemia Is Diagnosed
Treatment typically involves starting intravenous (IV) fluids (saline solution delivered through a needle into a vein) to rehydrate the body quickly. It also may require IV insulin to bring down blood sugar levels.
Potassium and sometimes sodium phosphate replenishment may also be required to support cell function.
If you are hospitalized due to HHNS, you may be kept overnight for observation. The main goal of treatment of this condition is to identify the underlying factors, whether that’s an infection, a certain medication, or poor blood sugar management.
It is imperative that a person experiencing HHNS receive urgent professional medical care, as complications may include seizures, coma, swelling of the brain, or even death if left untreated.
Prevention
How Is HHNS Different From Diabetic Ketoacidosis (DKA)?
DKAis also a serious condition and potentially life-threatening if not treated promptly. In contrast to HHNS, DKA is almost exclusively a condition that occurs in people with type 1 diabetes.
HHNS doesnotproduce ketones, and the symptoms of DKA are different, including:
A Word From Verywell
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Adeyinka A, Kondamudi NP.Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC, Hyperosmolar Hyperglycemic Nonketotic Syndrome). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.Fayfman M, Pasquel FJ, Umpierrez GE.Management of hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state.Med Clin North Am. 2017;101(3):587-606. doi:10.1016/j.mcna.2016.12.011French EK, Donihi AC, Korytkowski MT.Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients.BMJ. 2019;365:l1114. doi:10.1136/bmj.l1114Pasquel FJ, Umpierrez GE.Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment.Diabetes Care. 2014;37(11):3124-31. doi:10.2337/dc14-0984University of Michigan.Serum osmolality.National Library of Medicine: MedlinePlus.Diabetic hyperglycemic hyperosmolar syndrome.Umpierrez G, Korytkowski M.Diabetic emergencies: ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia.Nat Rev Endocrinol. 2016;12(4):222-32. doi:10.1038/nrendo.2016.15Kreider KE.Updates in the management of diabetic ketoacidosis.J Nurse Pract. 2018;14(8);591-597. doi:10.1016/j.nurpra.2018.06.013
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Adeyinka A, Kondamudi NP.Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC, Hyperosmolar Hyperglycemic Nonketotic Syndrome). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.Fayfman M, Pasquel FJ, Umpierrez GE.Management of hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state.Med Clin North Am. 2017;101(3):587-606. doi:10.1016/j.mcna.2016.12.011French EK, Donihi AC, Korytkowski MT.Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients.BMJ. 2019;365:l1114. doi:10.1136/bmj.l1114Pasquel FJ, Umpierrez GE.Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment.Diabetes Care. 2014;37(11):3124-31. doi:10.2337/dc14-0984University of Michigan.Serum osmolality.National Library of Medicine: MedlinePlus.Diabetic hyperglycemic hyperosmolar syndrome.Umpierrez G, Korytkowski M.Diabetic emergencies: ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia.Nat Rev Endocrinol. 2016;12(4):222-32. doi:10.1038/nrendo.2016.15Kreider KE.Updates in the management of diabetic ketoacidosis.J Nurse Pract. 2018;14(8);591-597. doi:10.1016/j.nurpra.2018.06.013
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Adeyinka A, Kondamudi NP.Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC, Hyperosmolar Hyperglycemic Nonketotic Syndrome). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.Fayfman M, Pasquel FJ, Umpierrez GE.Management of hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state.Med Clin North Am. 2017;101(3):587-606. doi:10.1016/j.mcna.2016.12.011French EK, Donihi AC, Korytkowski MT.Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients.BMJ. 2019;365:l1114. doi:10.1136/bmj.l1114Pasquel FJ, Umpierrez GE.Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment.Diabetes Care. 2014;37(11):3124-31. doi:10.2337/dc14-0984University of Michigan.Serum osmolality.National Library of Medicine: MedlinePlus.Diabetic hyperglycemic hyperosmolar syndrome.Umpierrez G, Korytkowski M.Diabetic emergencies: ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia.Nat Rev Endocrinol. 2016;12(4):222-32. doi:10.1038/nrendo.2016.15Kreider KE.Updates in the management of diabetic ketoacidosis.J Nurse Pract. 2018;14(8);591-597. doi:10.1016/j.nurpra.2018.06.013
Adeyinka A, Kondamudi NP.Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC, Hyperosmolar Hyperglycemic Nonketotic Syndrome). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
Fayfman M, Pasquel FJ, Umpierrez GE.Management of hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state.Med Clin North Am. 2017;101(3):587-606. doi:10.1016/j.mcna.2016.12.011
French EK, Donihi AC, Korytkowski MT.Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients.BMJ. 2019;365:l1114. doi:10.1136/bmj.l1114
Pasquel FJ, Umpierrez GE.Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment.Diabetes Care. 2014;37(11):3124-31. doi:10.2337/dc14-0984
University of Michigan.Serum osmolality.
National Library of Medicine: MedlinePlus.Diabetic hyperglycemic hyperosmolar syndrome.
Umpierrez G, Korytkowski M.Diabetic emergencies: ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia.Nat Rev Endocrinol. 2016;12(4):222-32. doi:10.1038/nrendo.2016.15
Kreider KE.Updates in the management of diabetic ketoacidosis.J Nurse Pract. 2018;14(8);591-597. doi:10.1016/j.nurpra.2018.06.013
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