HHS; Hyperglycemic hyperosmolar coma; Nonketotic hyperglycemic hyperosmolar coma (NKHHC); Hyperosmolar nonketotic coma (HONK); Hyperglycemic hyperosmolar non-ketotic state; Diabetes - hyperosmolar
Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of type 2 diabetes. It involves extremely high blood sugar (glucose) level without the presence of ketones.
HHS is a condition of:
Buildup of ketones in the body (ketoacidosis) may also occur. But it is unusual and is often mild compared with diabetic ketoacidosis.
HHS is more often seen in people with type 2 diabetes who don't have their diabetes under control. It may also occur in those who have not been diagnosed with diabetes. The condition may be brought on by:
Normally, the kidneys try to make up for a high glucose level in the blood by allowing the extra glucose to leave the body in the urine. But this also causes the body to lose water. If you do not drink enough water, or you drink fluids that contain sugar and keep eating foods with carbohydrates, you become very dehydrated. When this occurs, the kidneys are no longer able to get rid of the extra glucose. As a result, the glucose level in your blood can become very high, sometimes more than 10 times the normal amount.
The loss of water also makes the blood more concentrated than normal. This is called hyperosmolarity. It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances. This draws the water out of the body's other organs, including the brain.
Risk factors include:
Symptoms may include any of the following:
Symptoms may get worse over days or weeks.
Other symptoms that may occur with this disease:
The health care provider will examine you and ask about your symptoms and medical history. The exam may show that you have:
Test that may be done include:
Evaluation for possible causes may include:
At the start of treatment, the goal is to correct the water loss. This will improve the blood pressure, urine output, and circulation. Blood sugar will also decrease.
Fluids and potassium will be given through a vein (intravenously). This must be done carefully. High glucose level is treated with insulin given through a vein.
People who develop HHS are often already ill. If not treated right away, seizures, coma, or death may result.
Untreated, HHS may lead to any of the following:
This condition is a medical emergency. Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of HHS.
Controlling type 2 diabetes and recognizing the early signs of dehydration and infection can help prevent HHS. Have a "sick-day plan" so you will be prepared for days when you are not going to be eating well. Also try to order your diabetes and other medicines in 3-month amounts so you will be less likely to run out of them.
Crandall JP, Shamoon H. Diabetes mellitus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 216.
Lebovitz HE. Hyperglycemia secondary to nondiabetic conditions and therapies. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 42.
Sinha A. Diabetic emergencies. In: Bersten AD, Handy JM, eds. Oh's Intensive Care Manual. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 59.BACK TO TOP
Review Date: 1/9/2022
Reviewed By: Robert Hurd, MD, Professor of Endocrinology and Health Care Ethics, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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