Non-Ketotic Hyperosmoloar Coma


Earlier, we discussed Diabetic Ketoacidosis, and in this article, we will quick review Hyperosmolar Non-Ketotic Coma, another acute complication of DM.


Also referred to as Hyperosmolar Hyperglycemic State (HHS), Non-Ketotic Hyperosmolar Coma (NKHOC) is an acute complication of diabetes meillitus type 2. The sudden increased level of sugar result in Hypotension and Tachycardia, complicating into Coma and Death.

Clinical Features

The patient presents with symptoms while examination reveals signs as follows :-


Classically, patient presents with :-

  • Elderly
  • History of Polyuria of several weeks with weight loss and decrease oral intake
  • Mental confusion


The signs observed in non-ketotic hyperosmolar coma are somewhat similar to Diabetic Ketoacidosis:

  • Tachycardia
  • Hypotension
  • Dehydration
  • Altered sensorium and coma

Noting point is, like diabetic ketoacidosis, NKHOC doesn’t follow Nausea, Vomiting, Abdominal Pain, Kussmaul respiration and Ketosis.


Following tests help diagnose Non-ketotic hyperosmolar com:

  • Blood sugar – 900-1100 mg/dL
  • Serum osmolality > 350mosm/kg
  • Pre-renal azotemia
  • Pseudo hyponatremia
  • pH normal, i.e no acidosis
  • Ketonuria is absent, i.e no ketosis


The management of NKHOC is as:

  • Fluid – Total fluid deficit (9-10 L) should be reversed over 1-2 day.
  • Initially, give normal saline to stabilize the patients hemodynamically (To bring systolic BP above 90mm Hg). After that, give 0.45% saline.
  • Regular Insulin to be given intravenous.
  • Subcutaneous heparin because these patients are prone to Venous thrombosis.
Read more-   Potassium Balance vs Hypokalemia vs Hyperkalemia


Please enter your comment!
Please enter your name here