Hyperglycemic hyperosmolar nonketotic syndrome

Dagmara Reingardienė

Clinic of Intensive Care, Kaunas University of Medicine, Lithuania

Key words: hyperglycemic hyperosmolar nonketotic syndrome, hyperosmolar hyperglycemic state, hyperosmolar hyperglycemia, hyperosmolar hyperglycemic nonketotic coma.

Summary. Hyperglycemic hyperosmolar nonketotic syndrome and diabetic ketoacidosis are two of the most serious acute complications of diabetes. Hyperglycemic hyperosmolar nonketotic syndrome is found mostly in type 2 diabetic patients. It is characterized by extreme dehydration and neurologic symptoms, which are related directly to the degree of hyperosmolarity. Hyperglycemic hyperosmolar nonketotic syndrome continues to be important cause of morbidity and mortality among patients with diabetes in spite of major advances in the understanding of its pathogenesis and more uniform agreement about its diagnosis and treatment.

This article reviews data about precipitating factors, pathogenesis, carbohydrate, water and electrolyte metabolism in this hyperosmolar hyperglycemic state. The review discusses diagnostic procedures, laboratory evaluation, differential diagnosis and treatment: replacement of fluid and electrolytes, low-dose insulin therapy.

A discussion of complications management of hyperosmolar hyperglycemia, mortality rate and prevention are included in this review.

Correspondence to D. Reingardienė, Clinic of Intensive Care, Kaunas University of Medicine, Eivenių 2, 3007 Kaunas, Lithuania

Received 30 March 2003, accepted 1 April 2003