Introduction
Acute decompensation of diabetes mellitus that occurs mainly in the elderly and is characterized by hyperosmolarity, hyperglycemia, and severe dehydration rarely occurring with neurological signs and absence of acidosis or ketonemia results in a syndrome called the hyperosmolar nonketotic diabetic coma. However, there is a high mortality seen in cases of diabetic ketoacidosis. This is because beta cells in the pancreas continue to produce insulin, but the amount is insufficient. Therefore, hyperosmolar hyperglycemic syndrome is a potentially fatal complication of type 2 diabetes. The mortality rate was about 20 %, which is about ten times higher than the mortality seen in diabetic ketoacidosis. Cardiovascular problems such as stroke, myocardial infarction, and angina pectoris may also trigger a stress response. This leads to the release of hormones with increased blood glucose levels, causing dehydration and osmotic diuresis leading to hyperosmolar nonketotic diabetic coma.
What Is Hyperosmolar Nonketotic Diabetic Coma?
The hyperosmolar hyperglycemic syndrome is a serious complication of diabetes mellitus. This condition is most commonly seen in obese patients. As a consequence of obesity with a high body mass index, there is resistance to insulin action in peripheral tissues.
What Are the Alternative Names for Hyperosmolar nonketotic diabetic coma?
Alternative names of the condition include the following:
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Hyperosmolar nonketotic coma.
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Diabetes - hyperosmolar.
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Non ketotic hyper osmolar coma.
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Hyperglycemic hyperosmolar nonketotic state.
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Hyperosmolar hyperglycemic syndrome.
What Is the Cause of Hyperosmolar Nonketotic Diabetic Coma?
People who have diabetes mellitus have too much glucose in their blood. Glucose builds up when their bodies do not make enough insulin or have trouble producing insulin for utilization. Insulin is the naturally producing hormone produced by the beta cells of the pancreas that helps the body utilize sugar for energy. The hyperosmolar hyperglycemic syndrome occurs when the person's blood sugar increases too high, called hyperglycemia, for a longer time. The excess sugar is passed through the urine, which causes the person to urinate more frequently. As a result, one loses a lot of fluid, leading to extreme thirst (dehydration). Hyperglycemic hyperosmolar syndrome is a complication of type 2 diabetes. It involves extremely high blood sugar levels without the presence of ketones. Hyperglycemic hyperosmolar syndrome is a complication of:
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Extreme lack of water (dehydration).
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Decreased alertness or consciousness in many cases.
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Extremely high blood sugar glucose levels.
The hyperosmolar hyperglycemic syndrome most commonly develops in patients with type 2 diabetes mellitus that is not well managed.
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The patient may have a heart attack or stroke.
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Stop taking medications to manage their diabetes.
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Having illness or infection such as urinary tract infection or pneumonia.
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Certain medications, such as diuretics or steroids, can cause the syndrome.
Usually, the kidneys will try to make up for high blood glucose levels by allowing the extra glucose to leave the body through the urine. However, this may also cause the body to lose water. If one does not drink enough water, or one drinks fluids that contain sugar, and intake of foods that contain carbohydrates when one becomes dehydrated. This occurs when the kidneys are no longer able to get free of the extra glucose. As a result, blood glucose may become very high, sometimes multiplying ten times the normal amount. The loss of water may also make the blood more concentrated than normal. This is called hyperosmolarity, a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances, which draws the water out of the body's other organs, such as the brain.
Risk factors may include the following such as:
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Older age.
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Poor kidney function.
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Limited access to water, especially in patients with dementia or bed bound.
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Heart failure.
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Stopping or running out of insulin or other medicines that lower the glucose level.
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Impaired thirst.
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Poor management of diabetes or not following the physician's treatment plan.
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A stressful situation such as a heart attack, stroke, or recent surgery.
What Are the Symptoms of Hyperosmolar Nonketotic Diabetic Coma?
The hyperglycemic hyperosmolar nonketotic syndrome is also called hyperglycemic hyperosmolar syndrome. The symptoms may include the following. Such as,
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Feeling weak.
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Nausea.
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Fever.
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Coma.
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Increased thirst and urination.
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Confusion.
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Weight loss.
Symptoms may get worse over the days or weeks. Other symptoms may occur with this disease. Such as:
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Speech impairment.
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Problems with movement.
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Loss of feeling or the function of muscles.
What Are the Diagnostic Tests Taken?
The health care provider may examine and ask about one's symptoms and medical history. The exam may show the following:
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Low systolic blood pressure.
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Fever higher than 100.4 degrees F (38 degrees C).
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Increased heart rate.
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Extreme dehydration.
The tests may also include the following:
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Ketone test.
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Blood glucose, potassium, and bicarbonate.
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Blood urea nitrogen levels and creatinine levels.
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Blood glucose, potassium, and bicarbonate.
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Blood osmolarity (concentration).
Evaluation for possible causes may include the following:
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Chest X-ray.
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Electrocardiogram.
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COVID-19 and influenza testing.
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Blood and urine cultures.
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Urinalysis.
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Computer tomography of the head.
What Is the Management of Hyperosmolar Nonketotic Diabetic Coma?
The main aim of the treatment at the beginning is to treat the water loss. It may improve blood pressure, circulation, and urine output so the water loss will decrease. Fluids and potassium are then given through a vein intravenously. It should be given carefully. High glucose level is treated with insulin that is given through the vein.
What Are the Possible Complications of Hyperosmolar Nonketotic Diabetic Coma?
The untreated hyperosmolar hyperglycemic syndrome may cause possible complications such as:
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Blood clot formation.
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Brain swelling.
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Increased blood acid level.
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Shock.
How Can One Prevent Hyperosmolar Nonketotic Diabetic Coma?
The best way to prevent hyperosmolar nonketotic diabetic coma is by managing a healthy lifestyle and controlling diabetes. One should observe the following steps:
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One should avoid drinking alcohol on an empty stomach.
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Take a healthy diet.
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Get more rest and check one's blood sugar more often when at risk.
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Take insulin and other diabetic medications as prescribed by the doctor.
Conclusion
Hyperosmolar nonketotic diabetic coma is a serious complication of type 2 diabetes. Most patients may end up admitted to the intensive care unit. To improve patient outcomes, an interprofessional approach with good communication, care, and coordination with regular visits with dieticians, endocrinologists, and healthcare providers is needed.
