Non Ketonic Hyperglycemic coma

Overview

a metabolic derangement in which there is an abnormally high serum glucose level without ketoacidosis. It can occur as a complication of borderline and unrecognized diabetes mellitus, in pancreatic disorders that interfere with the production of insulin, and in conditions marked by an excess of steroids, as in steroid therapy or acute stress conditions.Hyperosmolality, resulting from the extremely high concentration of sugar in the blood, causes a shift of water from the intracellular fluid (the less concentrated solution) into the blood (the higher concentrated solution). This results in cellular dehydration. Another symptom of HHNK, polyuria, occurs because the high plasma osmolality prevents the normal osmotic return of water to the blood by the renal tubules, and it is excreted in the urine. This leads to a decreased blood volume, which severely hampers the kidney's excretion of glucose and a vicious cycle is begun. [ [http://medical-dictionary.thefreedictionary.com/hyperglycemic+hyperosmolar+nonketotic+coma+(HHNK) hyperglycemic hyperosmolar nonketotic coma (HHNK) - definition of hyperglycemic hyperosmolar nonketotic coma (HHNK) in the Medical dictionary - by the Free Online Medical Dict... ] ]

The disease differs from diabetic ketoacidosis (DKA) by the fact that the body still releases (or is non-resistant to) just enough insulin that the body does not go into "starvation mode". In DKA, the body cannot use the sugar in the blood and must begin to metabolize fat and muscle tissue for sustainance, which produces acids and ketones as byproducts. This can manifest itself in "fruity" smelling breath and urine (the smell of nail-polish remover). Because the body is so stressed, blood sugar levels typically are above 250 but below 600. With non ketonic hyperglycemia, the patient (because of the slight amount of insulin still circulating) is typically capable of MUCH higher blood sugar levels; as high as 1500 mg/dL in rare cases due to the fact that the blood pH is not as affected as a patient in DKA.

As with DKA, the first concern is to control the inevitable dehydration

References