What Is a Nonketotic Hyperosmolar Coma?

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  • Written By: T. Carrier
  • Edited By: John Allen
  • Last Modified Date: 04 November 2018
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A nonketotic hyperosmolar coma — also known as hyperosmolar nonketotic state or diabetic hyperglycemic hyperosmolar syndrome — is a dangerous complication of type 2 diabetes. Low insulin levels combined with high blood sugar levels create an atmosphere for development of the condition. Dehydration, reflex problems, and cognitive disturbances represent some symptoms. In advanced cases, unconsciousness or death may result. Treatments may range from intravenous fluid intake to insulin injections.

Type 2 diabetes is a condition that develops over time. It is characterized by erratic levels of glucose sugar in the blood. An estimated norm for blood sugar concentrations in the absence of food intake runs around 100 milligrams (about 0.004 ounces) or below. Both high and low amounts of glucose can cause serious physical symptoms, ranging from jitteriness to unconsciousness. Nonketotic hyperosmolar coma is a primary risk factor for individuals with extremely elevated blood sugar levels.

A complicating illness can help foster conditions for nonketotic hyperosmolar coma. Heart attacks, strokes, or infections are some common precedents of this ailment. These illnesses can cause further damage to already low insulin levels and reduce fluid intake, causing dehydration. Insulin is the substance that controls blood sugar levels in the body, and insulin suppression can subsequently lead to abnormally high concentrations of blood sugar. The afflicted individual also experiences frequent urination, exacerbating the dehydration.


Several warning signs accompany nonketotic hyperosmolar coma. In addition to the urination problems, motor and mental disturbances characterize the condition. Slow reflexes may occur as early indicators, with possible progression to tremors or seizures. Like other forms of diabetic coma, the condition will often end in unconsciousness.

Consequences for untreated nonketotic hyperosmolar coma are severe. Mental function may continue deteriorating. The risk of developing damaging blood clots also significantly increases. Body water and potassium levels suffer as well. In some cases, the complications can even turn lethal.

This condition is differentiated from the other primary causes of diabetic coma: hypoglycemia and ketoacidosis. The latter ailment occurs mostly in type 1 diabetes, as opposed to type 2. While both conditions can develop from low insulin levels, a nonketotic hyperosmolar coma does not produce a significant amount of ketone bodies, which are fatty acid by-products that accumulate in the liver. A hypoglycemia coma, on the other hand, happens when blood sugar levels become dangerously low.

Treatment for nonketotic hyperosmolar coma consists of three primary components. Insulin injections can restore proper blood sugar balance. As for addressing the damage, physicians may give patients intravenous fluids to correct potassium depletion and dehydration. Further, infusing substances called electrolytes into the patient can combat potassium problems. Identifying and treating any underlying conditions or suspect drug regimens are essential steps as well.



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