Nonketotic Hyperosmolar Syndrome

Nonketotic Hyperosmolar Syndrome – General Information

The Nonketotic Hyperosmolar Syndrome (also known as Hyperglycemic Hyperosmolar Nonketotic Syndrome, Hyperglycemic Hyperosmolar Nonketotic Coma, Hyperglycemic Hyperosmolar Coma, Hyperosmolar Hyperglycemic Syndrome, Hyperosmolar Hyperglycemic Nonketotic Syndrome and abbreviated NKHS) is a metabolic derangement (or complication) of type two of Diabetes Mellitus (also abbreviated DM) which usually occurs in the setting of physiologic stress and has a rate of mortality of 40%. This medical condition usually appears after a person has been experiencing a symptomatic hyperglycemia in which the fluid intake is not helpful to prevent the dehydration or in elderly people who have mild or undiagnosed diabetes type 2.  If the Nonketotic Hyperosmolar Syndrome is not recognized and treated it progresses to coma followed by death. Coma usually appears in a small number of cases about 9-10% before the diagnosis. If this medical condition is recognized and treated properly, the patients have high chances of recovery. The patients who survive will be diagnosed with diabetes type 2 and in most of the cases they do not need further treatment with insulin. In the Nonketotic Hyperosmolar Syndrome the blood sugar levels are very high and the patient’s body tries to get rid of the excess of sugar by redirecting it intro the urine. The patients usually feel the need to go to the bathroom very often (the urine is very dark) and to drink plenty of liquids. They should listen to the needs of their organism, otherwise they may become dehydrated. If the patients do not see a doctor the dehydration will become severe and will lead to seizures, coma and even death.

Nonketotic Hyperosmolar Syndrome – Symptoms

It is well known the fact that any medical disorder (including Nonketotic Hyperosmolar Syndrome) can trigger a variety of symptoms. Therefore, some of this medical condition's most uncommon symptoms have not been listed (mentioned) here. This is why we strongly recommend you to contact your personal health care provider whenever you develop any unusual, bothersome or unpleasant symptoms. Your personal physician will be able to tell you if you are suffering from Nonketotic Hyperosmolar Syndrome or from any other medical disorder. Here is a list of the most common symptoms that a person who suffers from Nonketotic Hyperosmolar Syndrome, may experience, although each individual experiences them differently. The primary symptom of this medical condition is consciousness which can vary from confusion and disorientation to coma which as we said before appears as a result of the dehydration. The coma may develop with or without the prerenal azotemia, hypersomolarity (meaning the thickening of the blood) or hyperglycemia. The patients may also experience generalized or local seizures and also hemiplagia. The signs of this medical condition are the followings: high blood sugar levels, dry and parched mouth, extreme thirst (which will disappear) warm skin, dry skin, high fever, loss of vision which can be temporary or permanent, hallucinations, sleepiness and confusion, weakness on one side of the body. In the case that a patient has any of these symptoms it is better for him or her to contact immediately his doctor or personal health care provider in order to establish the diagnostic and for the doctor to prescribe an appropriate treatment, before the coma installs.

Nonketotic Hyperosmolar Syndrome – Treatment

The Nonketotic Hyperosmolar Syndrome is usually suspected when a patient has elevated glucose levels in the specimen taken from the finger in the course of a workup of the altered mental status. The patients are usually recommended to measure the levels of electrolytes, BUN, creatinine, glucose, ketones and osmolarity in the blood and also their urine should also be tested for ketones. The levels of the K are in most of the cases normal, but the Na may be either low or high. The levels of creatinine and BUN are usually increased. The fluid deficit in the majority of the cases is about 10 L and this leads to acute circulatory collapse which results in death. During the autopsy the doctor will find widespread thrombosis which results from disseminated intravascular coagulation and in some of the cases bleeding can occur as a result of the disseminated coagulation. The Nonketotic Hyperosmolar Syndrome can have as complications the following medical conditions: aspiration pneumonia, acute renal failure and acute respiratory distress syndrome.

The goals of the Nonketotic Hyperosmolar Syndrome are the rehydration of the patients, the correction of the hyperglycemia and to restore the electrolyte balance. After the rehydration and the electrolytes are in normal limits the doctors or personal health care providers may recommend the patients to begin the treatment with insulin. The patients who have been diagnosed with this medical condition are usually admitted in the intensive care unit in order to get intravenous insulin, electrolytes and insulin and to correct the cardiac, pulmonary, renal and neurological status. The patients will have their electrolytes levels monitored, because the osmotic diuresis in all of the cases leads to an imbalance in the electrolyte levels which cannot be corrected until the metabolisms of the patients are stable. The treatment of the patients who are suffering from the Nonketotic Hyperosmolar Syndrome is usually based on the replacement of the fluids, the maintenance of the electrolyte levels, especially the potassium level which is very important, on administrating insulin in order to treat the hyperglycemia, on the supportive care in case any complications appear and on aggressive therapy for the underlying conditions which can precipitate the Nonketotic Hyperosmolar Syndrome such as the infections of the urinary tract.

Here is one of the most common drugs used in the treatment of the patients who are suffering from this medical condition: Humulin R InnoLets - this is a fast-acting drug which is a form of the insulin. This drug helps the patient’s organism to use the sugar properly and to lower the levels of the glucose in the blood, which is helpful in the treatment of the diabetes. This drug should not be used by patients who are allergic to any of the constituents of it or by the patients who have an episode of low blood sugar level. Before starting the treatment the patients should inform their doctor if they are pregnant or planning to become pregnant, if they are allergic to any substances, if they consume alcohol or smoke, if they use more than 3 injections with insulin a day, if they have kidney, liver, nerve, adrenal, pituitary or thyroid problems and if they have high blood levels of sodium or are on a diet with low salt levels.