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Hyperosmolar Hyperglycemic Nonketotic State

What is hyperosmolar hyperglycemic nonketotic state?

Hyperosmolar hyperglycemic nonketotic state (HHNS) is a life-threatening emergency. It is caused by very high blood sugar (hyperglycemia). Most people with HHNS have a blood sugar level over 600 mg/dL. This is several times higher than a normal blood sugar. Your kidneys try to get rid of the extra sugar by putting more sugar into the urine. This makes you urinate more and you lose too much fluid and get dehydrated. As you lose fluids, your blood gets thicker and your blood sugar level gets too high for your kidneys to manage. With the high blood sugar and dehydration, the sodium and potassium in your body gets out of balance. The imbalance of fluids, blood sugar, and minerals in the body can lead to life-threatening problems with the brain.

Without prompt treatment HHNS can cause death.

What is the cause?

HHNS is most common in adults with type 2 diabetes. Having diabetes means that there is too much sugar (glucose) in your blood. Because type 2 diabetes may not cause symptoms for many years, HHNS could happen before you know that you have diabetes.

Possible causes of HHNS are:

  • Not knowing you have diabetes
  • Not taking diabetes medicines as prescribed
  • Getting an infection. If you have diabetes, an infection can raise your blood sugar above your usual levels. This may happen before you have symptoms of an infection.
  • Having diabetes and taking a diuretic (water pill) for high blood pressure.
  • Not checking your blood sugar regularly. If you don’t check your blood sugar regularly, your blood sugar can get too high.
  • Abusing drugs or alcohol

What are the symptoms?

Symptoms may include:

  • Feeling tired all the time
  • Blurry vision
  • Dry mouth
  • Confusion, especially in older adults
  • Muscle cramps
  • Fever

Over time, you get more confused and have trouble thinking, remembering, reasoning, and planning. This can worsen to seizures and coma.

How is it diagnosed?

The healthcare provider will ask about your symptoms and medical history and examine you. Tests may include blood and urine tests.

How is it treated?

The first emergency treatment is IV fluids. This helps bring your sodium and potassium levels back to normal. You will be given IV insulin to bring your blood sugar down. You will be closely checked for brain swelling, kidney failure, and other serious problems. This usually means you need to stay at the hospital for at least a few days. Your blood will be checked every couple of hours to make sure your treatment is working.

You will be treated for any infection or other medical problems.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. Take all medicines as prescribed. Check your blood sugar as often as recommended by your healthcare provider

Ask your provider:

  • How and when you will hear your test results
  • How long it will take to recover
  • If there are activities you should avoid and when you can return to your normal activities
  • How to take care of yourself at home
  • What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

What can I do to prevent HHNS?

The best way to prevent HHNS is to:

  • Take your diabetes medicines exactly as prescribed.
  • Talk with your healthcare provider if you have questions about your care.
  • Use your home glucose meter to check your blood sugar as often as your provider recommends.
  • Ask your provider when you should call about high blood sugar, for example, a blood sugar over 240.
  • Check your blood sugar more often when you are sick. Work with your healthcare provider to develop a sick-day plan.
  • If you have diabetes, report any symptoms of infection, such as fever, a cough, or cloudy urine to your provider right away.

You can get more information from:

Developed by RelayHealth.
Adult Advisor 2015.1 published by RelayHealth.
Last modified: 2015-01-05
Last reviewed: 2015-01-05
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright ©1986-2015 McKesson Corporation and/or one of its subsidiaries. All rights reserved.

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