| Risk Factors
Hyperosmolar nonketotic coma occurs in people with
diabetes. It is a life-threatening event. Seek medical attention immediately if you think you have any symptoms of an impending hyperosmolar nonketotic coma.
Hyperosmolar nonketotic coma is a
of very high blood glucose levels. Blood glucose often rises to these levels because of an illness or infection.
The body will try to get rid of the extra blood glucose through the urine. The frequency and volume of urination will increase. Unfortunately, this process also washes out other substances in your blood. Some of these substances are very important to your brain. Low levels of these substances can lead to
coma, and eventually death.
The chance of hyperosmolar nonketotic coma is higher in older adults.
Other factors that may increase your chance of hyperosmolar nonketotic coma include having diabetes and:
Symptoms that may occur before the hyperosmolar nonketotic coma may include:
- Mental confusion
- Frequent urination
- Nausea or vomiting
- Dry mouth
- Warm, dry skin without sweating
- High fever
- Vision loss
- Weakness or strange movements on one side of the body with or without seizures
If you arrive at the hospital in a hyperosmolar nonketotic coma, your vital signs will be monitored. The levels of glucose and other substances in your blood will be tested with:
- Blood tests—can also test kidney function
- Urine tests
- Urine, blood, and sputum cultures
may also be done to check your heart's electrical activity.
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You will likely need treatment in the emergency room and/or the intensive care unit at the
Treatment will focus on restoring the correct balance of substances in your blood including glucose. Treatment may include:
- Fluids and minerals through an IV—to replace substances you lost and improve your urine output.
- Insulin through an IV—to help control your blood glucose levels.
You may need additional treatment, such as antibiotics, if an infection led to the coma.
To help prevent hyperosmolar nonketotic coma:
- Monitor your blood glucose levels regularly. Your doctor can instruct you about how often to check your levels, and what the numbers mean.
- Drink plenty of fluids throughout the day.
- Talk with your doctor about how to manage your blood glucose when you are sick.
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Updated January 12, 2013. Accessed September 4, 2013.
Kim DW, Moon Y, et al. Blood-brain barrier disruption is
involved in seizure and hemianopsia in nonketotic hyperglycemia.
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Kitabchi AE. Hyperglycemic crises in diabetes mellitus: diabetic ketoacidosis and hyperglycemic hyperosmolar state.
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Ondo WG. Hyperglycemic nonketotic states and other metabolic imbalances.
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Stoner GD. Hyperosmolar hyperglycemic state.
Am Fam Physician.
Hyperosmolar hyperglycemic nonketotic syndrome (HHNS). American Diabetes Association website. Available at:
Accessed September 4, 2013.
Last reviewed September 2013 by Kim Carmichael, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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