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Hyperglycemic Hyperosmolar Nonketotic Coma

MedGen UID:
43778
•Concept ID:
C0020457
•
Disease or Syndrome
Synonyms: Coma, Hyperglycemic Hyperosmolar Nonketotic; Coma, Hyperosmolar Nonketotic; Coma, Nonketotic Hyperglycemic; Coma, Nonketotic Hyperosmolar; Comas, Hyperosmolar Nonketotic; Comas, Nonketotic Hyperosmolar; Hyperglycemic Coma, Nonketotic; Hyperosmolar Coma, Nonketotic; Hyperosmolar Comas, Nonketotic; Hyperosmolar Hyperglycemic Nonketotic Coma; Hyperosmolar Nonketotic Coma; Hyperosmolar Nonketotic Comas; Nonketotic Coma, Hyperosmolar; Nonketotic Comas, Hyperosmolar; Nonketotic Hyperglycemic Coma; Nonketotic Hyperosmolar Coma; Nonketotic Hyperosmolar Comas

Definition

A serious complication of TYPE 2 DIABETES MELLITUS. It is characterized by extreme HYPERGLYCEMIA; DEHYDRATION; serum hyperosmolarity; and depressed consciousness leading to COMA in the absence of KETOSIS and ACIDOSIS. [from MeSH]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVHyperglycemic Hyperosmolar Nonketotic Coma

Professional guidelines

PubMed

Osmotic equilibrium between extracellular fluid and cerebrospinal fluid during treatment of hyperglycemic, hyperosmolar, nonketotic coma.
Carrol HJ, Arieff AI
Trans Assoc Am Physicians 1971;84:113-21. PMID: 5005980

Recent clinical studies

Etiology

Management of Hyperosmolar Hyperglycaemic State (HHS) in Adults: An updated guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care Group.
Mustafa OG, Haq M, Dashora U, Castro E, Dhatariya KK; Joint British Diabetes Societies (JBDS) for Inpatient Care Group
Diabet Med 2023 Mar;40(3):e15005. Epub 2022 Dec 21 doi: 10.1111/dme.15005. PMID: 36370077Free PMC Article
Clinical Outcomes in Patients With Isolated or Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: A Retrospective, Hospital-Based Cohort Study.
Pasquel FJ, Tsegka K, Wang H, Cardona S, Galindo RJ, Fayfman M, Davis G, Vellanki P, Migdal A, Gujral U, Narayan KMV, Umpierrez GE
Diabetes Care 2020 Feb;43(2):349-357. Epub 2019 Nov 8 doi: 10.2337/dc19-1168. PMID: 31704689Free PMC Article
Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients.
Karslioglu French E, Donihi AC, Korytkowski MT
BMJ 2019 May 29;365:l1114. doi: 10.1136/bmj.l1114. PMID: 31142480
ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state.
Wolfsdorf JI, Glaser N, Agus M, Fritsch M, Hanas R, Rewers A, Sperling MA, Codner E
Pediatr Diabetes 2018 Oct;19 Suppl 27:155-177. doi: 10.1111/pedi.12701. PMID: 29900641
Hyperglycemic crisis.
Van Ness-Otunnu R, Hack JB
J Emerg Med 2013 Nov;45(5):797-805. Epub 2013 Jun 18 doi: 10.1016/j.jemermed.2013.03.040. PMID: 23786780

Diagnosis

ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state.
Glaser N, Fritsch M, Priyambada L, Rewers A, Cherubini V, Estrada S, Wolfsdorf JI, Codner E
Pediatr Diabetes 2022 Nov;23(7):835-856. doi: 10.1111/pedi.13406. PMID: 36250645
Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.
Fayfman M, Pasquel FJ, Umpierrez GE
Med Clin North Am 2017 May;101(3):587-606. doi: 10.1016/j.mcna.2016.12.011. PMID: 28372715Free PMC Article
Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Advances in the Management of Hyperglycemic Crises (UK Versus USA).
Dhatariya KK, Vellanki P
Curr Diab Rep 2017 May;17(5):33. doi: 10.1007/s11892-017-0857-4. PMID: 28364357Free PMC Article
Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia.
Umpierrez G, Korytkowski M
Nat Rev Endocrinol 2016 Apr;12(4):222-32. Epub 2016 Feb 19 doi: 10.1038/nrendo.2016.15. PMID: 26893262
Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment.
Pasquel FJ, Umpierrez GE
Diabetes Care 2014 Nov;37(11):3124-31. doi: 10.2337/dc14-0984. PMID: 25342831Free PMC Article

Therapy

Management of Hyperosmolar Hyperglycaemic State (HHS) in Adults: An updated guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care Group.
Mustafa OG, Haq M, Dashora U, Castro E, Dhatariya KK; Joint British Diabetes Societies (JBDS) for Inpatient Care Group
Diabet Med 2023 Mar;40(3):e15005. Epub 2022 Dec 21 doi: 10.1111/dme.15005. PMID: 36370077Free PMC Article
Hyperosmolar Hyperglycemic State.
Stoner GD
Am Fam Physician 2017 Dec 1;96(11):729-736. PMID: 29431405
Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.
Fayfman M, Pasquel FJ, Umpierrez GE
Med Clin North Am 2017 May;101(3):587-606. doi: 10.1016/j.mcna.2016.12.011. PMID: 28372715Free PMC Article
Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia.
Umpierrez G, Korytkowski M
Nat Rev Endocrinol 2016 Apr;12(4):222-32. Epub 2016 Feb 19 doi: 10.1038/nrendo.2016.15. PMID: 26893262
Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment.
Pasquel FJ, Umpierrez GE
Diabetes Care 2014 Nov;37(11):3124-31. doi: 10.2337/dc14-0984. PMID: 25342831Free PMC Article

Prognosis

Clinical Outcomes in Patients With Isolated or Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: A Retrospective, Hospital-Based Cohort Study.
Pasquel FJ, Tsegka K, Wang H, Cardona S, Galindo RJ, Fayfman M, Davis G, Vellanki P, Migdal A, Gujral U, Narayan KMV, Umpierrez GE
Diabetes Care 2020 Feb;43(2):349-357. Epub 2019 Nov 8 doi: 10.2337/dc19-1168. PMID: 31704689Free PMC Article
Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.
Fayfman M, Pasquel FJ, Umpierrez GE
Med Clin North Am 2017 May;101(3):587-606. doi: 10.1016/j.mcna.2016.12.011. PMID: 28372715Free PMC Article
Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia.
Umpierrez G, Korytkowski M
Nat Rev Endocrinol 2016 Apr;12(4):222-32. Epub 2016 Feb 19 doi: 10.1038/nrendo.2016.15. PMID: 26893262
Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment.
Pasquel FJ, Umpierrez GE
Diabetes Care 2014 Nov;37(11):3124-31. doi: 10.2337/dc14-0984. PMID: 25342831Free PMC Article
Hyperosmolar hyperglycemic state.
Stoner GD
Am Fam Physician 2005 May 1;71(9):1723-30. PMID: 15887451

Clinical prediction guides

Combined diabetic ketoacidosis and hyperosmolar hyperglycemic state in type 1 diabetes mellitus induced by immune checkpoint inhibitors: Underrecognized and underreported emergency in ICIs-DM.
Zhang W, Chen J, Bi J, Ding N, Chen X, Wang Z, Jiao Y
Front Endocrinol (Lausanne) 2022;13:1084441. Epub 2023 Jan 4 doi: 10.3389/fendo.2022.1084441. PMID: 36686495Free PMC Article
Predicting readmission due to severe hyperglycemia after a hyperglycemic crisis episode.
Liao WT, Lee CC, Kuo CL, Lin KC
Diabetes Res Clin Pract 2022 Oct;192:110115. Epub 2022 Oct 8 doi: 10.1016/j.diabres.2022.110115. PMID: 36220515
Clinical Outcomes in Patients With Isolated or Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: A Retrospective, Hospital-Based Cohort Study.
Pasquel FJ, Tsegka K, Wang H, Cardona S, Galindo RJ, Fayfman M, Davis G, Vellanki P, Migdal A, Gujral U, Narayan KMV, Umpierrez GE
Diabetes Care 2020 Feb;43(2):349-357. Epub 2019 Nov 8 doi: 10.2337/dc19-1168. PMID: 31704689Free PMC Article
Trends in Hyperglycemic Crisis Hospitalizations and in- and out-of-Hospital Mortality in the Last Decade Based on Korean National Health Insurance Claims Data.
You JH, Song SO, Park SH, Park KH, Nam JY, Kim DW, Kim HM, Kim DJ, Lee YH, Lee BW
Endocrinol Metab (Seoul) 2019 Sep;34(3):275-281. doi: 10.3803/EnM.2019.34.3.275. PMID: 31565880Free PMC Article
Treatment of hyperglycaemic hyperosmolar non-ketotic syndrome.
Levine SN, Sanson TH
Drugs 1989 Sep;38(3):462-72. doi: 10.2165/00003495-198938030-00007. PMID: 2680438

Recent systematic reviews

Combined diabetic ketoacidosis and hyperosmolar hyperglycemic state in type 1 diabetes mellitus induced by immune checkpoint inhibitors: Underrecognized and underreported emergency in ICIs-DM.
Zhang W, Chen J, Bi J, Ding N, Chen X, Wang Z, Jiao Y
Front Endocrinol (Lausanne) 2022;13:1084441. Epub 2023 Jan 4 doi: 10.3389/fendo.2022.1084441. PMID: 36686495Free PMC Article
Acute stroke-like deficits associated with nonketotic hyperglycemic hyperosmolar state: an illustrative case and systematic review of literature.
Rossi S, Romoli M, Urbinati G, Benini M, Russo M, D'Anna L, Abu-Rumeileh S, Sacco S, Querzani P, Foschi M
Neurol Sci 2022 Aug;43(8):4671-4683. Epub 2022 Apr 28 doi: 10.1007/s10072-022-06088-7. PMID: 35482160Free PMC Article
Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature.
Pal R, Banerjee M, Yadav U, Bhattacharjee S
Diabetes Metab Syndr 2020 Nov-Dec;14(6):1563-1569. Epub 2020 Aug 18 doi: 10.1016/j.dsx.2020.08.015. PMID: 32853901Free PMC Article

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