Hyperglycemic Hyperosmolar Nonketotic Coma (Nonketotic Hyperglycemic Coma)

A serious complication of TYPE 2 DIABETES MELLITUS. It is characterized by extreme HYPERGLYCEMIA; DEHYDRATION; serum hyperosmolarity; and depressed consciousness leading to COMA in the absence of KETOSIS and ACIDOSIS.

Also Known As:

Nonketotic Hyperglycemic Coma; Hyperosmolar Hyperglycemic Nonketotic Coma; Hyperosmolar Hyperglycemic State; Hyperosmolar Hyperglycemic Syndrome; Hyperosmolar Nonketotic Coma; Nonketotic Hyperosmolar Coma; Coma, Hyperosmolar Nonketotic; Coma, Nonketotic Hyperglycemic; Coma, Nonketotic Hyperosmolar; Comas, Hyperosmolar Nonketotic; Comas, Nonketotic Hyperosmolar; Hyperglycemic Coma, Nonketotic; Hyperglycemic State, Hyperosmolar; Hyperglycemic States, Hyperosmolar; Hyperglycemic Syndrome, Hyperosmolar; Hyperglycemic Syndromes, Hyperosmolar; Hyperosmolar Coma, Nonketotic; Hyperosmolar Comas, Nonketotic; Hyperosmolar Hyperglycemic States; Hyperosmolar Hyperglycemic Syndromes; Hyperosmolar Nonketotic Comas; Nonketotic Coma, Hyperosmolar; Nonketotic Comas, Hyperosmolar; Nonketotic Hyperosmolar Comas; Syndrome, Hyperosmolar Hyperglycemic; Syndromes, Hyperosmolar Hyperglycemic; Coma, Hyperglycemic Hyperosmolar Nonketotic

Networked: 115 relevant articles (1 outcomes, 4 trials/studies)

Relationship Network

Disease Context: Research Results

Endocrine System Diseases: 968
- Diabetes Mellitus: 56563
  - Diabetes Complications: 7591
    - Diabetic Coma: 338
      - Hyperglycemic Hyperosmolar Nonketotic Coma: 115

Related Diseases

1.	Rhabdomyolysis
2.	Diabetic Ketoacidosis (Ketoacidosis, Diabetic)
3.	Hypoglycemia (Reactive Hypoglycemia)
4.	Venous Thromboembolism
5.	Hyperglycemia

Experts

1.	Stoner, Gregg D: 2 articles (12/2017 - 05/2005)
2.	Hsu, Jin-Yi: 1 article (02/2022)
3.	Huang, Huei-Kai: 1 article (02/2022)
4.	Lin, Shu-Man: 1 article (02/2022)
5.	Liu, Peter Pin-Sung: 1 article (02/2022)
6.	Loh, Ching-Hui: 1 article (02/2022)
7.	Wei, Wei-Ting: 1 article (02/2022)
8.	Wu, Ying-Ying: 1 article (02/2022)
9.	Anno, Takatoshi: 1 article (01/2022)
10.	Bardia, Aditya: 1 article (01/2022)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Hyperglycemic Hyperosmolar Nonketotic Coma:

1.	Insulin (Novolin)FDA Link 05/01/2006 - "Application of insulin in type 2 diabetics is justified by the effort to prevent nonketotic hyperosmolar coma. " 09/21/1979 - "Low-dose insulin for diabetic nonketotic hyperosmolar coma." 03/24/1975 - "Letter: Hyperosmolar, nonketotic coma: choice of insulin." 08/01/2020 - "The patient presented with an atypical hyperosmolar hyperglycemic state and diabetic ketoacidosis but recovered after insulin pump treatment and fluid supplementation. " 10/01/2019 - "The "Underwater Part of the Iceberg" of Insulin Administration for Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: Electrolytics Disorders."
2.	Glucagon (Glukagon)FDA Link 09/23/1974 - "Plasma glucagon in nonketotic hyperosmolar coma." 05/01/1987 - "This study demonstrates that the hepatic unresponsiveness to glucagon in terms of its ketone body production by aging may be one of the major causes of hyperosmolar nonketotic coma in elderly people." 03/01/2018 - " Insulin deficiency or resistence and increased concentrations of counterreulatory hormones (glucagon, catecholamines, cortisol and growth hormone) are responsible for the development of diabetic ketoacidosis and the hyperosmolar hyperglycemic state. "
3.	KetonesIBA 05/01/1987 - "This study demonstrates that the hepatic unresponsiveness to glucagon in terms of its ketone body production by aging may be one of the major causes of hyperosmolar nonketotic coma in elderly people." 03/01/2013 - "Measurement of A1C, blood urea nitrogen, creatinine, serum glucose, electrolytes, pH, and serum ketones; complete blood count; urinalysis; electrocardiography; and calculation of anion gap and osmolar gap can differentiate diabetic ketoacidosis from hyperosmolar hyperglycemic state, gastroenteritis, starvation ketosis, and other metabolic syndromes, and can assist in diagnosing comorbid conditions. "
4.	AnticoagulantsIBA 02/17/2022 - "Previous studies in Western countries have shown that a hyperosmolar hyperglycemic state (HHS) is associated with an increased risk of venous thromboembolism (VTE); in these cases, prophylactic anticoagulant treatment is suggested. "
5.	ipragliflozinIBA 11/07/2023 - "Fifty patients completed the study, one patient stopped ipragliflozin at 4 weeks because of the development of hyperosmolar hyperglycemic syndrome. "
6.	Glucose (Dextrose)FDA LinkGeneric 01/01/2021 - "On arrival the patient had a serum glucose concentration of >1,600 mg/dL, and hyperosmolar hyperglycemic syndrome (HHS) was diagnosed. " 10/01/2017 - "End-Stage Renal Disease Increases Rates of Adverse Glucose Events When Treating Diabetic Ketoacidosis or Hyperosmolar Hyperglycemic State." 08/01/1984 - "This model allows for the marked hyperglycemia and minimal ketosis of diabetic nonketotic hyperosmolar coma, as well as the glucose and ketoacid concentrations in other presentations of acutely decompensated diabetes." 10/01/2017 - "This article describes a retrospective study comparing the rates of adverse glucose events (defined as hypoglycemia or a decrease in glucose >200 mg/dL/h) between patients with ESRD and those with normal kidney function who were admitted with diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). " 11/01/2016 - "Various reports of disturbances in glucose metabolism in the form of new onset diabetes mellitus, exacerbation of preexisting diabetes mellitus, diabetic ketoacidosis, hyperosmolar nonketotic coma, acute pancreatitis, and increased adiposity have been reported. "
7.	SodiumIBA 02/01/2023 - "Our case highlights the importance of cautious correction of serum hyperglycemia and monitoring serum sodium levels in patients with a hyperosmolar hyperglycemic state (HHS)." 10/20/2023 - "Clinicians should consider ODS in patients with DKA and a hyperosmolar hyperglycemic state displaying unconsciousness and neurological manifestations, including chorea, even without substantial changes in serum sodium levels. " 01/01/2014 - "The laboratory data on admission showed hyperosmolar hyperglycemic state, according to the following findings; glucose 1,058 mg/dl, serum osmolality 328 mOsm/l and serum sodium 119 mEq/l. " 08/01/2020 - "An atypical hyperosmolar hyperglycemic state and diabetic ketoacidosis induced by sodium-glucose cotransporter-2 inhibitors: A case report." 05/01/2023 - "We identified adult admissions with diabetic ketoacidosis and the hyperosmolar hyperglycemic state who had measured osmolality results available contemporaneously with sodium, urea and glucose values. "
8.	ElectrolytesIBA 12/01/1987 - "Fluid and electrolyte disorders associated with diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic coma." 02/04/2021 - "A 28-year-old female with type 1 diabetes, hypertension, seizure disorder, and end-stage renal disease on hemodialysis was brought from a shelter with two days of unresponsiveness and developed ODS after hyperosmolar hyperglycemic state in long-standing uncontrolled diabetes with normal serum electrolyte levels." 03/01/2013 - "Proper care of patients with diabetes during the perioperative period is crucial for preventing acute complications such as hyperglycemia, hypoglycemia, diabetic ketoacidosis, hyperosmolar hyperglycemic state, dehydration, and electrolyte imbalances. " 01/01/2003 - "This article reviews data about precipitating factors, pathogenesis, carbohydrate, water and electrolyte metabolism in this hyperosmolar hyperglycemic state. " 03/01/2013 - "Hyperglycemia and diabetes place hospitalized patients at greater risk for serious complications such as infections, diabetic ketoacidosis, hyperosmolar hyperglycemic state, dehydration, electrolyte imbalances, greater antibiotic use, and lengthened hospitalization. "
9.	Blood Glucose (Blood Sugar)IBA 07/01/1977 - "Blood glucose should be measured during and after general anesthesia in patients who are potential candidates for hyperglycemic hyperosmolar nonketotic coma." 01/01/2022 - "Hyperosmolar hyperglycemic state (HHS) is a rare complication in children and a life-threatening emergency that presents with a significant increase in blood sugar and hyperosmolarity with or without low ketosis. " 12/01/2017 - "Hyperosmolar hyperglycemic state is a life-threatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. " 05/01/2005 - "Hyperosmolar hyperglycemic state is a life-threatening emergency manifested by marked elevation of blood glucose, hyperosmolarity, and little or no ketosis. " 09/01/2013 - "Diabetic ketoacidosis has a more rapid onset than a hyperosmolar hyperglycemic state and often presents with a comparatively lower blood sugar and the presence of acidosis. "
10.	Hormones (Hormone)IBA 11/01/2021 - "The hyperosmolar hyperglycemic state (HHS), an acute complication of diabetes mellitus with plasma hyperosmolarity, promotes the secretion of anti-diuretic hormone (ADH) and reduces the storage of ADH. " 12/01/2003 - "Diabetic ketoacidosis (DKA) and the hyperosmolar hyperglycemic state (HHS) are serious acute decompensations of type 1 and 2 diabetes mellitus due to various degrees of insulin deficiency and increased levels of counterregulatory hormones. " 05/01/2023 - "Diabetes ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening complications of diabetes resulting from an imbalance between insulin and the glucose counter-regulatory hormones. " 01/01/1981 - "The results suggest that the normal levels of lipolytic hormones may account for the normal plasma free fatty acids and the absence of ketosis found in children with nonketotic hyperosmolar coma, in contrast to the elevated levels of lipolytic hormones and ketone bodies in ketoacidotic diabetic coma." 03/01/2018 - " Insulin deficiency or resistence and increased concentrations of counterreulatory hormones (glucagon, catecholamines, cortisol and growth hormone) are responsible for the development of diabetic ketoacidosis and the hyperosmolar hyperglycemic state. "

Therapies and Procedures

1.	Renal Dialysis (Hemodialysis) 12/01/2018 - "Improvement in renal prognosis with prompt hemodialysis in hyperosmolar hyperglycemic state-related rhabdomyolysis: A case report." 02/04/2021 - "A 28-year-old female with type 1 diabetes, hypertension, seizure disorder, and end-stage renal disease on hemodialysis was brought from a shelter with two days of unresponsiveness and developed ODS after hyperosmolar hyperglycemic state in long-standing uncontrolled diabetes with normal serum electrolyte levels."
2.	Therapeutics 08/10/2004 - "[Progress in diagnosis of and therapy for nonketotic hyperosmolar coma]." 01/01/1987 - "A patient who developed hyperosmolar, hyperglycemic, nonketotic coma (HHNC) while receiving home total parenteral nutrient (TPN) therapy is described, and the etiology, clinical features, and treatment of HHNC are reviewed. " 01/01/1987 - "Hyperosmolar, hyperglycemic, nonketotic coma in a patient receiving home total parenteral nutrient therapy." 10/01/1983 - "All three cases demonstrate that hyperosmolar hyperglycemic nonketotic coma is a serious potential complication of systemic steroidal therapy, even in a short course of treatment such as is often used in ophthalmology." 06/01/1980 - "Early diagnosis is necessary for institution of appropriate therapy, and to decrease the morbidity associated with nonketotic hyperglycemic coma, which may evolve."
3.	Length of Stay 01/01/2019 - "Moderate-intensity insulin therapy for diabetic ketoacidosis and hyperosmolar hyperglycemic state resulted in improvements in hospital and ICU length of stay, which appeared to be associated with decreased glycemic variability." 01/01/2019 - "The hypothesis of this study was that moderate-intensity insulin therapy decreases hospital length of stay and prevalence of hypoglycemia in patients with diabetic ketoacidosis and hyperosmolar hyperglycemic state. " 01/01/2019 - "Moderate-Intensity Insulin Therapy Is Associated With Reduced Length of Stay in Critically Ill Patients With Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State."
4.	Fluid Therapy (Oral Rehydration Therapy) 01/01/2019 - "She was diagnosed with hyperosmolar hyperglycemic state, and fluid therapy was started. " 01/01/1989 - "Initial treatment for this and hyperosmolar nonketotic coma is rehydration. " 04/01/1990 - "Concepts of fluid therapy in diabetic ketoacidosis and hyperosmolar hyperglycemic nonketotic coma."
5.	Drug Therapy (Chemotherapy) 09/01/1992 - "On the 6th day after 2nd cycle chemotherapy, she was confused, and we diagnosed her as a case of hyperosmolar nonketotic coma (HNC) on the 7th day. " 09/01/1992 - "[A case of hyperosmolar nonketotic coma occurring during chemotherapy in lung cancer]." 12/01/2018 - "The development of a hyperglycemic crisis in platinum-based chemotherapy-treated head and neck cancer patients, such as hyperosmolar hyperglycemic state (HHS), has been reported. " 09/01/1999 - "A case of hyperosmolar nonketotic coma occurring during chemotherapy using cisplatin for gallbladder cancer."