March 25, 2015

Hyperglycemic Hyperosmolar Nonketotic Syndrome – Part 2

Hyperosmolar Hyperglycemic Nonketotic Syndrome, or HHNS, may include any of the following symptoms:
  • Coma
  • Confusion
  • Convulsions
  • Dry mouth, dry tongue
  • Fever
  • Increased thirst
  • Increased urination (at the beginning of the syndrome)
  • Lethargy
  • Nausea
  • Weakness
  • Weight loss
Symptoms may get worse over days or even weeks.  Warning - this condition requires immediate medical attention!

Other symptoms that may occur with this disease:
  • Loss of feeling or function of muscles
  • Problems with movement
  • Speech impairment
The doctor or nurse will examine you and ask about your symptoms and medical history. The exam may show that you have:
  • Extreme dehydration
  • Fever higher than 100.4° Fahrenheit
  • Increased heart rate
  • Low systolic blood pressure
Test that may be done include:
  • Blood osmolarity (concentration)
  • BUN and creatinine levels
  • Blood sodium level
  • Ketone test
  • Blood glucose
Evaluation for possible causes may include:
  • Blood cultures
  • Chest x-ray
  • Electrocardiogram (ECG)
  • Urinalysis
The goal of treatment is to correct the dehydration. This will improve the blood pressure, urine output, and circulation. Fluids and potassium will be given intravenously (IV). The high glucose level is treated with insulin also given through a vein and sometimes as part of the same IV port.

Patients who develop this syndrome are often already ill. The death rate with this condition is as high as 40%.

Possible complications include:
  • Acute circulatory collapse (shock)
  • Blood clot formation
  • Brain swelling (cerebral edema)
  • Increased blood acid levels (lactic acidosis)
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 diabetic hyperglycemic hyperosmolar syndrome.

Managing type 2 diabetes and recognizing the early signs of dehydration and infection can help prevent this condition. This task will sometimes fall to the caregiver for some elderly patients that are bedridden.

For more discussion, read this from the Mayo Clinic.

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