Diabetic coma Nonketotic hyperosmolar coma(patient information): Difference between revisions
No edit summary |
m (Bot: Removing from Primary care) |
||
| (One intermediate revision by one other user not shown) | |||
| Line 3: | Line 3: | ||
'''For the WikiDoc page for this topic, click [[Diabetic coma|here]]''' | '''For the WikiDoc page for this topic, click [[Diabetic coma|here]]''' | ||
{{CMG}}; | {{CMG}}; {{AE}} {{KD}} | ||
==Overview== | ==Overview== | ||
Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of type 2 diabetes that involves extremely high blood sugar (glucose) levels without the presence of | Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of [[type 2 diabetes]] that involves extremely high blood sugar (glucose) levels without the presence of [[ketone]]s. [[Ketone]]s are byproducts of fat breakdown. | ||
==What are the symptoms of Nonketotic hyperosmolar coma?== | ==What are the symptoms of Nonketotic hyperosmolar coma?== | ||
* Coma | * [[Coma]] | ||
* Confusion | * [[Confusion]] | ||
* | * [[Convulsion]]s | ||
* Fever | * [[Fever]] | ||
* Increased thirst | * Increased thirst | ||
* Increased urination (at the beginning of the syndrome) | * Increased urination (at the beginning of the syndrome) | ||
* Lethargy | * [[Lethargy]] | ||
* Nausea | * [[Nausea]] | ||
* Weakness | * [[Weakness]] | ||
* Weight loss | * [[Weight loss]] | ||
Symptoms may get worse over a period of days or weeks. | Symptoms may get worse over a period of days or weeks. | ||
| Line 31: | Line 31: | ||
* Extremely high blood sugar (glucose) levels | * Extremely high blood sugar (glucose) levels | ||
* Extreme lack of water (dehydration) | * Extreme lack of water ([[dehydration]]) | ||
* Decreased consciousness | * [[Decreased consciousness]] | ||
The buildup of ketones in the body (ketoacidosis) may also occur. However, it is unusual and often mild. | The buildup of ketones in the body (ketoacidosis) may also occur. However, it is unusual and often mild. | ||
| Line 38: | Line 38: | ||
This condition is usually seen in people with type 2 diabetes. It may occur in those who have not been diagnosed with diabetes, or in people who have not been able to control their diabetes. The condition may be brought on by: | This condition is usually seen in people with type 2 diabetes. It may occur in those who have not been diagnosed with diabetes, or in people who have not been able to control their diabetes. The condition may be brought on by: | ||
* Infection | [[*]] Infection | ||
* Other illness such as heart attack or stroke | * Other illness such as [[heart attack]] or [[stroke]] | ||
* Medications that lower glucose tolerance or increase fluid loss (in people who are losing or not getting enough fluid) | * Medications that lower glucose tolerance or increase fluid loss (in people who are losing or not getting enough fluid) | ||
Normally, the | Normally, the [[kidney]]s try to make up for high glucose levels in the [[blood]] by allowing the extra glucose to leave the body in the urine. If you do not drink enough fluids, or you drink fluids that contain sugar, the kidneys can no longer get rid of the extra glucose. [[Glucose]] levels in the blood can become very high as a result. The blood then becomes much more concentrated than normal ([[hyperosmolarity]]). | ||
Hyperosmolarity is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances that normally cause water to move into the bloodstream. This draws the water out of the body's other organs, including the brain. Hyperosmolarity creates a cycle of increasing blood glucose levels and dehydration. | Hyperosmolarity is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances that normally cause water to move into the bloodstream. This draws the water out of the body's other organs, including the brain. Hyperosmolarity creates a cycle of increasing blood glucose levels and dehydration. | ||
==Who is at highest risk?== | ==Who is at highest risk?== | ||
Risk factors include: | Risk factors include: | ||
* A stressful event such as infection, heart attack, stroke, or recent surgery | * A stressful event such as [[infection]], [[heart attack]], [[stroke]], or recent surgery | ||
* Congestive heart failure | * [[Congestive heart failure]] | ||
* Impaired thirst | * Impaired thirst | ||
* Limited access to water (especially in patients with dementia or who are bedbound) | * Limited access to water (especially in patients with dementia or who are bedbound) | ||
* Older age | * Older age | ||
* Poor kidney function | * Poor kidney function | ||
* Poor management of | * Poor management of [[diabete]]s -- not following the treatment plan as directed | ||
* Stopping insulin or other medications that lower glucose levels | * Stopping [[insulin]] or other medications that lower glucose levels | ||
==Diagnosis== | ==Diagnosis== | ||
The doctor or nurse will examine you and ask questions about your symptoms and medical history. The exam may show that you have: | The doctor or nurse will examine you and ask questions about your symptoms and medical history. The exam may show that you have: | ||
* Extreme dehydration | * Extreme [[dehydration]] | ||
* Fever higher than 100.4 degrees Fahrenheit | * Fever higher than 100.4 degrees Fahrenheit | ||
* Increased heart rate | * [[Increased heart rate]] | ||
* Low systolic blood pressure | * [[Low systolic blood pressure]] | ||
Test that may be done include: | Test that may be done include: | ||
* Blood osmolarity (concentration) | * Blood osmolarity (concentration) | ||
* BUN and creatinine levels | * [[BUN]] and [[creatinine]] levels | ||
* Blood sodium level | * Blood sodium level | ||
* Ketone test | * Ketone test | ||
| Line 96: | Line 95: | ||
Patients who develop this syndrome are often already ill. The death rate with this condition is as high as 40%. | Patients who develop this syndrome are often already ill. The death rate with this condition is as high as 40%. | ||
==Possible complications== | ==Possible complications== | ||
* Acute circulatory collapse (shock) | * Acute circulatory collapse ([[shock]]) | ||
* Blood clot formation | * Blood clot formation | ||
* Brain swelling (cerebral edema) | * Brain swelling ([[cerebral edema]]) | ||
* Increased blood acid levels (lactic acidosis) | * Increased blood acid levels ([[lactic acidosis]]) | ||
==Sources== | ==Sources== | ||
http://www.nlm.nih.gov/medlineplus/ency/article/000304.htm | http://www.nlm.nih.gov/medlineplus/ency/article/000304.htm | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Patient information]] | [[Category:Patient information]] | ||
| Line 112: | Line 112: | ||
[[Category:Medical conditions related to obesity]] | [[Category:Medical conditions related to obesity]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
Latest revision as of 21:20, 29 July 2020
|
Nonketotic hyperosmolar coma |
|
Where to find medical care for Nonketotic hyperosmolar coma? |
|---|
|
Nonketotic hyperosmolar coma On the Web |
|
Directions to Hospitals Treating Nonketotic hyperosmolar coma |
|
Risk calculators and risk factors for Nonketotic hyperosmolar coma |
For the WikiDoc page for this topic, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]
Overview
Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of type 2 diabetes that involves extremely high blood sugar (glucose) levels without the presence of ketones. Ketones are byproducts of fat breakdown.
What are the symptoms of Nonketotic hyperosmolar coma?
- Coma
- Confusion
- Convulsions
- Fever
- Increased thirst
- Increased urination (at the beginning of the syndrome)
- Lethargy
- Nausea
- Weakness
- Weight loss
Symptoms may get worse over a period of days or weeks.
Other symptoms that may occur with this disease:
- Dysfunctional movement
- Loss of feeling or function of muscles
- Speech impairment
What causes Nonketotic hyperosmolar coma?
Diabetic hyperglycemic hyperosmolar syndrome is a condition of:
- Extremely high blood sugar (glucose) levels
- Extreme lack of water (dehydration)
- Decreased consciousness
The buildup of ketones in the body (ketoacidosis) may also occur. However, it is unusual and often mild.
This condition is usually seen in people with type 2 diabetes. It may occur in those who have not been diagnosed with diabetes, or in people who have not been able to control their diabetes. The condition may be brought on by:
* Infection
- Other illness such as heart attack or stroke
- Medications that lower glucose tolerance or increase fluid loss (in people who are losing or not getting enough fluid)
Normally, the kidneys try to make up for high glucose levels in the blood by allowing the extra glucose to leave the body in the urine. If you do not drink enough fluids, or you drink fluids that contain sugar, the kidneys can no longer get rid of the extra glucose. Glucose levels in the blood can become very high as a result. The blood then becomes much more concentrated than normal (hyperosmolarity).
Hyperosmolarity is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances that normally cause water to move into the bloodstream. This draws the water out of the body's other organs, including the brain. Hyperosmolarity creates a cycle of increasing blood glucose levels and dehydration.
Who is at highest risk?
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
Diagnosis
The doctor or nurse will examine you and ask questions about your symptoms and medical history. The exam may show that you have:
- Extreme dehydration
- Fever higher than 100.4 degrees 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
- Very high blood glucose
Evaluation for possible causes may include:
- Blood cultures
- Chest x-ray
- Electrocardiogram (ECG)
- Urinalysis
When to seek urgent medical care?
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.
Treatment options
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 through a vein (intravenously). High glucose levels are treated with insulin given through a vein.
Where to find medical care for Nonketotic hyperosmolar coma?
Directions to Hospitals Treating Nonketotic hyperosmolar coma
Prevention
Controlling type 2 diabetes and recognizing the early signs of dehydration and infection can help prevent this condition.
What to expect (Outlook/Prognosis)?
Patients who develop this syndrome are often already ill. The death rate with this condition is as high as 40%.
Possible complications
- Acute circulatory collapse (shock)
- Blood clot formation
- Brain swelling (cerebral edema)
- Increased blood acid levels (lactic acidosis)
Sources
http://www.nlm.nih.gov/medlineplus/ency/article/000304.htm Template:WH Template:WS