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.

Hyperglycemic Hyperosmolar Nonketotic Syndrome – Part 1

Hyperosmolar Hyperglycemic Nonketotic Syndrome, or HHNS, is a serious condition most frequently seen in older persons. HHNS can happen to people with either type 1 or type 2 diabetes that is not being controlled properly; however, it occurs more often in people with type 2.

It may also occur in those who have not been diagnosed with diabetes. The condition may be brought on by:

• Infection
• Other illness, such as heart attack or stroke
• Medicines that decrease the effect of insulin in the body
• Medicines or conditions that increase fluid loss

In HHNS, blood sugar levels rise, and your body tries to get rid of the excess sugar by passing it into your urine. You will make lots of urine at first, and you will have to go to the bathroom more often. Later you may not have to go to the bathroom as often, and your urine becomes very dark. Also, you may become very thirsty. Remember, even if you are not thirsty, you need to drink plenty of liquids. If you don't drink enough liquids at this point, you will become dehydrated.

If HHNS continues, the severe dehydration will lead to seizures, coma, and eventually death. HHNS may take days or even weeks to develop. Learn the warning signs of HHNS.

• Blood sugar level over 600 mg/dl (33.3 mmol/L) or higher
• Dry, parched mouth
• Extreme thirst (although this may gradually disappear)
• Warm, dry skin that does not sweat
• High fever (over 101 degrees Fahrenheit, for example)
• Sleepiness or confusion
• Loss of vision
• Hallucinations (seeing or hearing things that are not there)
• Weakness on one side of the body

If you have any of these symptoms, call or have someone call your doctor immediately. HHNS requires immediate medical attention..

Risk factors include:

• A stressful event such as infection, heart attack, stroke, or recent surgery
• Congestive heart failure
• Impaired thirst
• Limited access to water (especially in patients with dementia or who are bedbound)
• Older age
• Poor kidney function
• Poor management of diabetes -- not following the treatment plan as directed
• Stopping insulin or other medications that lower glucose levels

HHNS only occurs when diabetes is uncontrolled. The best way to avoid HHNS is to check your blood glucose regularly. Many people check their blood sugar several times a day, such as before or after meals. Talk with your health care team about when to check and what the numbers mean. Learn self-monitoring of blood glucose (SMBG) and what the blood glucose readings mean when matched to a food log and other logs. Learn to keep your blood glucose levels as near to normal as possible and do not let them exceed 140 mg/dl (6.3 mmol/L). When your blood glucose levels consistently exceed this, or you are having too many episodes of hypoglycemia (lows) you should talk to your doctor. When you are sick, you should check your blood glucose more often, and drink a glass of water every hour. Work with your doctor to develop your own sick day plan.