Non-Ketotic Hyperosmoloar Coma

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Earlier, we discussed Diabetic Ketoacidosis, and in this article, we will quickly 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 Mellitus type 2. The sudden increased level of sugar results in Hypotension and Tachycardia, complicating into Coma and Death.

Clinical Features

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


Classically, the 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.


The 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 days.
  • Initially, give normal saline to stabilize the patient hemodynamically (To bring systolic BP above 90mm Hg). After that, give 0.45% saline.
  • Regular Insulin is to be given intravenously.
  • Subcutaneous heparin because these patients are prone to Venous thrombosis.

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