| Nonketotic hyperosmolar coma Classification and external resources |
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| ICD-9 | 250.2 |
|---|---|
| DiseasesDB | 29213 |
| eMedicine | emerg/264 |
| MeSH | D006944 |
Nonketotic hyperosmolar coma (nonketotic hyperglycaemia) is a type of diabetic coma associated with a high mortality seen in diabetes mellitus type 2. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Hyperglycemia, hyperglycaemia, or high blood sugar is a condition in which an excessive amount of Glucose circulates in the Blood plasma Diabetic coma is a Medical emergency in which a person with Diabetes mellitus is Comatose (unconscious because of one of the acute complications Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non - Insulin -dependent Diabetes mellitus (NIDDM or adult-onset diabetes is a metabolic The preferred term used by the American Diabetes Association is hyperosmolar nonketotic state (HNS). The American Diabetes Association, or the ADA is an American health organization providing Diabetes research information and advocacy Other commonly used names are hyperosmolar hyperglycemic nonketotic coma (HHNKC)[1] or hyperosmotic non-ketotic acidosis (HONK).
Contents |
Pathophysiology
| Diabetes mellitus
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| Types of Diabetes |
| Diabetes mellitus type 1 Diabetes mellitus type 2 Gestational diabetes Pre-diabetes: |
| Disease Management |
| Diabetes management: •Diabetic diet •Anti-diabetic drugs •Conventional insulinotherapy •Intensive insulinotherapy |
| Other Concerns |
| Cardiovascular disease
Diabetic comas: Diabetic myonecrosis |
| Blood tests |
| Blood sugar Fructosamine Glucose tolerance test Glycosylated hemoglobin |
Nonketotic coma is usually precipitated by an acute illness, myocardial infarction or stroke. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Diabetes mellitus type 1 (Type 1 diabetes Type I diabetes T1D T1DM IDDM juvenile diabetes is a form of Diabetes mellitus. Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non - Insulin -dependent Diabetes mellitus (NIDDM or adult-onset diabetes is a metabolic Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood Impaired fasting glycaemia (IFG is a pre-diabetic state of dysglycemia associated with insulin resistance and increased risk of cardiovascular pathology although of lesser risk than Impaired Glucose Tolerance (IGT is a pre- Diabetic state of dysglycemia that is associated with Insulin resistance and increased risk of cardiovascular pathology Diabetes is a Chronic disease with no cure As of 2008. It is associated with an impaired Glucose cycle, altering Metabolism. The diet most often recommended for people who suffer from Diabetes mellitus is high in Dietary fiber, especially soluble fiber but low in fat (especially Saturated fat Anti-diabetic drugs treat Diabetes mellitus by lowering Glucose levels in the blood Conventional insulinotherapy is a therapeutic regimen for treatment of Diabetes mellitus which contrasts with the newer Intensive insulinotherapy. Intensive insulinotherapy is a therapeutic regimen for Diabetes mellitus treatment Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Diabetic coma is a Medical emergency in which a person with Diabetes mellitus is Comatose (unconscious because of one of the acute complications Diabetic hypoglycemia describes a low blood glucose level occurring in a person with Diabetes mellitus. Diabetic ketoacidosis (DKA is a life-threatening complication in patients with diabetes mellitus Diabetic myonecrosis is a rare complication of Diabetes. It is caused by Infarcted Muscle tissue usually in the thigh Diabetic nephropathy ( nephropatia diabetica) also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive Kidney Diabetic neuropathies are neuropathic disorders that are associated with Diabetes mellitus. Diabetic retinopathy is Retinopathy (damage to the Retina) caused by complications of Diabetes mellitus, which can eventually lead to Blindness For women with Diabetes mellitus, Pregnancy can present some particular challenges for both mother and child Blood sugar, used in a physiological context is a misnomer and misleading Fructosamine is a compound that can be considered the result of a reaction between Fructose and Ammonia or an Amine (with a molecule of water being released A glucose tolerance test in medical practice is the administration of Glucose to determine how quickly it is cleared from the blood Glycosylated (or glycated hemoglobin ( hemoglobin A1c Hb1c, or HbA1c) is a form of Hemoglobin used primarily to identify the average A relative insulin deficiency leads to a serum glucose that is usually higher than 33mmol/l (600 mg/dl), and a resulting serum osmolarity that is greater than 350 mOsm. Glucose (Glc a Monosaccharide (or simple Sugar) also known as grape sugar, is an important Carbohydrate in Biology. Osmolarity is a measure of the osmoles of solute per Liter of solution while the osmolality is a measure of the osmoles of Solute per Kilogram This leads to polyuria (an osmotic diuresis), which, in turn, leads to volume depletion and hemoconcentration that causes a further increase in blood glucose level. In Medicine, polyuria is a condition characterized by the passage of large volumes of urine (at least 2 Ketosis is absent because the presence of some insulin inhibits lipolysis, unlike diabetic ketoacidosis. Ketosis (kiːˈtoʊsɪs is a state in Metabolism occurring when the Liver excessively converts fat into fatty acids and Ketone Insulin is a Hormone with intensive effects on both metabolism and several other body systems (eg vascular compliance Lipolysis is the breakdown of fat stored in fat cells During this process Free fatty acids are released into the bloodstream and circulate throughout the body Diabetic ketoacidosis (DKA is a life-threatening complication in patients with diabetes mellitus
Clinical presentation
The increasing hemoconcentration and volume depletion may result in:
- Hyperviscosity and increased risk of thrombosis
- Disturbed mentation
- Neurologic signs including focal signs such as sensory or motor impairments or focal seizures or motor abnormalities, including flacidity, depressed reflexes, tremors or fasciculations.
- Ultimately, if untreated, will lead to death.
Treatment
The treatment involves slow hydration, replacement of electrolytes and intravenous insulin. Insulin is a Hormone with intensive effects on both metabolism and several other body systems (eg vascular compliance Anticoagulants (such as low molecular weight heparins) are often commenced as there is a significant rate of thrombosis in patients with NKHC. An anticoagulant is a substance that prevents coagulation; that is it stops Blood from clotting In Medicine, low-molecular-weight heparin ( LMWH) is a class of Medication used as an Anticoagulant in diseases that feature Thrombosis Thrombosis is the formation of a blood Clot ( Thrombus) inside a Blood vessel, obstructing the flow of Blood through the Circulatory
References
- ^ Cirasino L, Thiella G, Invernizzi R, Silvani A, Ragaini S (1992). "Hyperosmolar hyperglycemic nonketotic coma in Waldenström's macroglobulinemia associated with type II diabetes and complicated by pulmonary tuberculosis". Recenti progressi in medicina 83 (4): 194–6. PMID 1626111.