Nonketotic Hyperosmolar Coma | Identifying and Treating NHC

If you have type 2 diabetes, you may be at risk for a complication called hyperglycemic hyperosmolar syndrome (HHS). In severe cases, this condition can lead to a coma. It’s important for diabetics to stay aware of their health to avoid dangerous situations occurring when their diabetes gets out of control.

Whether you or a family member has type 2 diabetes, we’ll provide information to keep you educated on the nonketotic hyperosmolar syndrome. If you think you are at risk for this disease, it is imperative you seek immediate medical attention.

Main Causes of Hyperglycemic Hyperosmolar Syndrome (and Nonketotic Hyperosmolar Coma)

When diabetics do not monitor their blood sugar levels regularly and treat themselves with insulin accordingly, they at risk for developing extremely high blood glucose levels which can lead to this condition, according to Medline Plus Medical Encyclopedia.

Extreme dehydration also leads to HHS.

In normal circumstances, the kidneys regulate high glucose levels by passing excess sugar through urine. If you don’t drink enough water, the blood sugar levels build up since you will not urinate as frequently as you need to.

When this happens, it’s also extremely dangerous for your kidneys, which can lead to other medical complications. Patients who are bedridden and have limited access to water are at an increased risk for this problem.

According to Medicine Net, when your body lacks sufficient fluids it has to pull water from your vital organs, including your brain. The condition is called hyperosmolarity and can lead to a coma. Hyperosmolarity is an extremely dangerous and potentially life-threatening condition.

It’s an emergency and requires immediate medical attention.

Risk Factors Associated with Diabetic Hyperglycemic Hyperosmolar Syndrome

We’ve already established people with type 2 diabetes have an increased risk of suffering from this dangerous condition. However, there are other medical conditions and situations which can also increase a patient’s chance of developing this condition, which can eventually lead to a coma.

Diabetics who ignore their treatment plan recommended by their doctors will increase the risk of HHS. Poor diet choices which can spike insulin levels or not properly injecting insulin into their bloodstream will cause serious medical complications.

According to the Mayo Clinic, these are common symptoms associated with HHS which cannot be ignored:

• Dry mouth
• Extreme thirst
• Irregular urination
• Loss of vision
• Hallucinations
• Drowsiness
• Confusion
• Dry and warm skin
• Seizures or convulsions
• Comas

Elderly patients are more susceptible to complications with HHS.

If they recently had surgery, an infection, stroke, or heart attack they are at an increased risk for falling into a nonketotic hyperosmolar coma. Poor kidney function and heart failure are additional problems these patients need to be aware of.

Treating Hyperosmolar Hyperglycemia

Typically, patients exhibiting the symptoms which could put them into a nonketotic hyperosmolar coma will get treated in the emergency room. According to Gregg D. Stoner, M.D. at the University of Illinois College of Medicine, there is a five-phase approach to treating this condition:

1. Vital rehydration through intravenous (IV) therapy
2. Replace electrolytes in the patient’s body
3. Administer insulin to balance the blood sugar levels to a health state
4. Diagnose any other medical problems caused by the hospitalization
5. Take steps to prevent this from happening again in the future

If patients have problems breathing or heart problems, they need close monitoring in the intensive care unit until doctors feel comfortable moving them to a less extreme room in the hospital.

Side Effects and Complications

According to the Patient Information resource page, people with HHS typically have other underlying medical problems and may already be in the hospital for another reason. Doctors need to use extreme caution when treating these patients to make sure the other medical conditions do not worsen during treatment.

It’s possible for these diabetics to go into shock if the IV is administered too quickly. Patients can also develop lactic acidosis, which is increased acid levels in the bloodstream, according to Diabetes Self-Management. Another side effect of HHS is blot clots or brain swelling, which can cause seizures, comas, and even death.

What Are Ketones and How do They Relate to Hyperosmolar Comas?

Diabetes Education Online states ketones and keto acids fuel a diabetic’s body when there are short levels of glucose in the system. It’s a normal function for people with diabetes to create ketones, but they can reach dangerous levels if the balance of insulin and other hormones is not properly managed and monitored.

Insulin levels are at their lowest at night, when people are sleeping and fasting. Just because you are asleep, it doesn’t mean your body does not need fuel. Your body uses fat cells to travel through the blood until they circulate to the liver. Once they reach the liver, your body processes the fat into ketones.

If there are insufficient insulin levels in your body, then the liver continues to make ketones, which causes your blood to be too acidic, according to the Diabetic Health Prevention Center. If this happens, it is an emergency situation, and the patient needs to be hospitalized immediately.

It’s possible for diabetics to fall into a coma when ketones reach dangerous levels. The time and severity of these comas vary from patient to patient, depending on their age, medical condition, and how fast they received treatment. These comas can also lead to death.

Final Thoughts

Since HHS is a condition affecting elderly diabetics with other health conditions, it’s unlikely they are in good enough health to read articles online about awareness, treatment, and prevention.

If you have a loved one with type 2 diabetes and other health issues, it’s important for you to be aware of these symptoms so you can get them medical attention when you notice irregular behavior. You can also take proper steps to prevent your loved one from slipping into a nonketotic hyperosmolar coma.

If you have recently been diagnosed with diabetes, it’s important to keep yourself educated on the HHS topic so you can make healthy life choices and prevent this from happening as you grow older.