{"id":5131,"date":"2025-11-30T22:50:50","date_gmt":"2025-12-01T03:50:50","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/?post_type=chapter&#038;p=5131"},"modified":"2025-12-07T23:09:55","modified_gmt":"2025-12-08T04:09:55","slug":"hhnk-hyperglycemic-hyperosmolar-non-ketotic-state","status":"web-only","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/chapter\/hhnk-hyperglycemic-hyperosmolar-non-ketotic-state\/","title":{"raw":"9p15 HHNK (Hyperglycemic, Hyperosmolar Non-Ketotic State)","rendered":"9p15 HHNK (Hyperglycemic, Hyperosmolar Non-Ketotic State)"},"content":{"raw":"<strong>HHNK (Hyperglycemic, Hyperosmolar Non-Ketotic State)<\/strong>\r\n<h1><strong>Overview<\/strong><\/h1>\r\n<ul>\r\n \t<li>Occurs over\u00a0<strong>several days<\/strong>\u00a0and can lead to\u00a0<strong>coma<\/strong>.<\/li>\r\n \t<li>Mainly affects\u00a0<strong>elderly<\/strong>\u00a0individuals with\u00a0<strong>Type 2 diabetes<\/strong>\u00a0or undiagnosed diabetes.<\/li>\r\n \t<li><strong>Gradual onset<\/strong>\u2014symptoms develop over\u00a0<strong>days or weeks<\/strong>.<\/li>\r\n \t<li>Often\u00a0<strong>missed or mistaken<\/strong>\u00a0for dementia due to overlapping symptoms.<\/li>\r\n<\/ul>\r\n<h1><strong>Cause and Pathophysiology<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Insulin levels<\/strong> are <strong>sufficient<\/strong> to prevent ketoacidosis but <strong>insufficient<\/strong> to prevent hyperglycemia.<\/li>\r\n \t<li>Common triggers:\r\n<ul>\r\n \t<li><strong>Biological Stressors:<\/strong>\u00a0infection, stroke, myocardial infarction.<\/li>\r\n \t<li><strong>Overindulgence<\/strong> in carbohydrates.<\/li>\r\n \t<li><strong>Poor management<\/strong>\u00a0of diabetes or missed medication.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Counter-regulatory hormones<\/strong> (glucagon, cortisol, epinephrine, norepinephrine) <strong>stimulate hepatic gluconeogenesis and glycogenolysis<\/strong>, pushing more glucose into the blood.<\/li>\r\n \t<li><strong>Cells are starved for glucose<\/strong> because insulin response is inadequate, leading to <strong>hyperglycemia<\/strong>.<\/li>\r\n<\/ul>\r\n<h1><strong>Effects of Hyperglycemia<\/strong><\/h1>\r\n<ul>\r\n \t<li>High blood glucose (<strong>&gt;600 mg\/dL<\/strong>).<\/li>\r\n \t<li>Excess glucose\u00a0<strong>pulls water into urine<\/strong>\u00a0(<strong>osmotic diuresis<\/strong>), causing <strong>severe dehydration<\/strong>.<\/li>\r\n \t<li><strong>Decreased blood volume<\/strong>\u00a0leads to\u00a0<strong>low blood pressure<\/strong>\u00a0(<strong>hypovolemia<\/strong>).<\/li>\r\n \t<li><strong>Concentration of red blood cells<\/strong>\u00a0increases (<strong>hemoconcentration<\/strong>): higher hematocrit.<\/li>\r\n \t<li><strong>Reduced urine output<\/strong>\u00a0over time due to dehydration.<\/li>\r\n<\/ul>\r\n<h1><strong>Symptoms and Clinical Signs<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Thirsty<\/strong> and <strong>dry skin<\/strong> (loss of turgor).<\/li>\r\n \t<li><strong>Headaches<\/strong> and feeling <strong>overheated<\/strong>.<\/li>\r\n \t<li><strong>Low urine output<\/strong> (dehydration phase).<\/li>\r\n \t<li><strong>Hypovolemia<\/strong> causes <strong>low blood pressure<\/strong>.<\/li>\r\n \t<li><strong>Neurological signs:<\/strong>\r\n<ul>\r\n \t<li><strong>Confusion<\/strong>,\u00a0<strong>decreased alertness<\/strong>.<\/li>\r\n \t<li><strong>Weakness<\/strong>,\u00a0<strong>abnormal reflexes<\/strong>.<\/li>\r\n \t<li><strong>Difficulty speaking<\/strong>.<\/li>\r\n \t<li><strong>Abdominal pain<\/strong>.<\/li>\r\n \t<li>Loss of\u00a0<strong>sensory function<\/strong>,\u00a0<strong>visual disturbances<\/strong>.<\/li>\r\n \t<li>Symptoms may resemble\u00a0<strong>stroke<\/strong>.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Decreased neural function<\/strong> can progress to <strong>seizures<\/strong> and <strong>coma<\/strong>.<\/li>\r\n<\/ul>\r\n<h1><strong>Effect on the Body<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>Dehydration and low blood volume<\/strong>\u00a0impair brain function.<\/li>\r\n \t<li><strong>Compensatory mechanisms<\/strong>\u00a0include increased heart rate and respiration.<\/li>\r\n \t<li><strong>Neuronal damage<\/strong>\u00a0due to lack of nutrients and oxygen.<\/li>\r\n \t<li>Can lead to\u00a0<strong>seizures<\/strong>,\u00a0<strong>loss of consciousness<\/strong>, and\u00a0<strong>death<\/strong>\u00a0if not treated promptly.<\/li>\r\n<\/ul>\r\n<h1><strong>Diagnosis<\/strong><\/h1>\r\n<ul>\r\n \t<li>Blood glucose\u00a0<strong>&gt;600 mg\/dL<\/strong>.<\/li>\r\n \t<li>Signs of\u00a0<strong>severe dehydration<\/strong>.<\/li>\r\n \t<li><strong>Elevated hematocrit<\/strong>\u00a0(more concentrated blood).<\/li>\r\n \t<li><strong>Electrolyte imbalance<\/strong>.<\/li>\r\n \t<li>Blood pH typically\u00a0<strong>normal or slightly acidic<\/strong>\u00a0(no ketoacidosis).<\/li>\r\n \t<li>Urinalysis:\r\n<ul>\r\n \t<li><strong>Glucosuria<\/strong>\u00a0(glucose in urine).<\/li>\r\n \t<li>Usually\u00a0<strong>no ketones<\/strong>\u00a0(hence non-ketotic).<\/li>\r\n \t<li>Polyuria initially followed by oliguria.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<h1><strong>Treatment<\/strong><\/h1>\r\n<ul>\r\n \t<li><strong>IV fluids<\/strong>\u00a0to correct dehydration.<\/li>\r\n \t<li>Electrolyte replacement (potassium, sodium).<\/li>\r\n \t<li><strong>Insulin therapy<\/strong>\u00a0to reduce blood glucose.<\/li>\r\n \t<li>Address\u00a0<strong>underlying stressors<\/strong>\u00a0(infection, stroke, etc.).<\/li>\r\n<\/ul>\r\n<h2><strong>Summary<\/strong><\/h2>\r\n<ul>\r\n \t<li>HHNK is a\u00a0<strong>life-threatening complication<\/strong>\u00a0mainly affecting\u00a0<strong>elderly<\/strong>\u00a0with\u00a0<strong>Type 2 diabetes<\/strong>.<\/li>\r\n \t<li>Characterized by\u00a0<strong>severe hyperglycemia<\/strong>\u00a0and\u00a0<strong>dehydration<\/strong>\u00a0without ketoacidosis.<\/li>\r\n \t<li><strong>Rapid treatment<\/strong>\u00a0with fluids, electrolytes, and insulin is essential to prevent\u00a0<strong>coma<\/strong>\u00a0and\u00a0<strong>death<\/strong>.<\/li>\r\n<\/ul>","rendered":"<p><strong>HHNK (Hyperglycemic, Hyperosmolar Non-Ketotic State)<\/strong><\/p>\n<h1><strong>Overview<\/strong><\/h1>\n<ul>\n<li>Occurs over\u00a0<strong>several days<\/strong>\u00a0and can lead to\u00a0<strong>coma<\/strong>.<\/li>\n<li>Mainly affects\u00a0<strong>elderly<\/strong>\u00a0individuals with\u00a0<strong>Type 2 diabetes<\/strong>\u00a0or undiagnosed diabetes.<\/li>\n<li><strong>Gradual onset<\/strong>\u2014symptoms develop over\u00a0<strong>days or weeks<\/strong>.<\/li>\n<li>Often\u00a0<strong>missed or mistaken<\/strong>\u00a0for dementia due to overlapping symptoms.<\/li>\n<\/ul>\n<h1><strong>Cause and Pathophysiology<\/strong><\/h1>\n<ul>\n<li><strong>Insulin levels<\/strong> are <strong>sufficient<\/strong> to prevent ketoacidosis but <strong>insufficient<\/strong> to prevent hyperglycemia.<\/li>\n<li>Common triggers:\n<ul>\n<li><strong>Biological Stressors:<\/strong>\u00a0infection, stroke, myocardial infarction.<\/li>\n<li><strong>Overindulgence<\/strong> in carbohydrates.<\/li>\n<li><strong>Poor management<\/strong>\u00a0of diabetes or missed medication.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Counter-regulatory hormones<\/strong> (glucagon, cortisol, epinephrine, norepinephrine) <strong>stimulate hepatic gluconeogenesis and glycogenolysis<\/strong>, pushing more glucose into the blood.<\/li>\n<li><strong>Cells are starved for glucose<\/strong> because insulin response is inadequate, leading to <strong>hyperglycemia<\/strong>.<\/li>\n<\/ul>\n<h1><strong>Effects of Hyperglycemia<\/strong><\/h1>\n<ul>\n<li>High blood glucose (<strong>&gt;600 mg\/dL<\/strong>).<\/li>\n<li>Excess glucose\u00a0<strong>pulls water into urine<\/strong>\u00a0(<strong>osmotic diuresis<\/strong>), causing <strong>severe dehydration<\/strong>.<\/li>\n<li><strong>Decreased blood volume<\/strong>\u00a0leads to\u00a0<strong>low blood pressure<\/strong>\u00a0(<strong>hypovolemia<\/strong>).<\/li>\n<li><strong>Concentration of red blood cells<\/strong>\u00a0increases (<strong>hemoconcentration<\/strong>): higher hematocrit.<\/li>\n<li><strong>Reduced urine output<\/strong>\u00a0over time due to dehydration.<\/li>\n<\/ul>\n<h1><strong>Symptoms and Clinical Signs<\/strong><\/h1>\n<ul>\n<li><strong>Thirsty<\/strong> and <strong>dry skin<\/strong> (loss of turgor).<\/li>\n<li><strong>Headaches<\/strong> and feeling <strong>overheated<\/strong>.<\/li>\n<li><strong>Low urine output<\/strong> (dehydration phase).<\/li>\n<li><strong>Hypovolemia<\/strong> causes <strong>low blood pressure<\/strong>.<\/li>\n<li><strong>Neurological signs:<\/strong>\n<ul>\n<li><strong>Confusion<\/strong>,\u00a0<strong>decreased alertness<\/strong>.<\/li>\n<li><strong>Weakness<\/strong>,\u00a0<strong>abnormal reflexes<\/strong>.<\/li>\n<li><strong>Difficulty speaking<\/strong>.<\/li>\n<li><strong>Abdominal pain<\/strong>.<\/li>\n<li>Loss of\u00a0<strong>sensory function<\/strong>,\u00a0<strong>visual disturbances<\/strong>.<\/li>\n<li>Symptoms may resemble\u00a0<strong>stroke<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Decreased neural function<\/strong> can progress to <strong>seizures<\/strong> and <strong>coma<\/strong>.<\/li>\n<\/ul>\n<h1><strong>Effect on the Body<\/strong><\/h1>\n<ul>\n<li><strong>Dehydration and low blood volume<\/strong>\u00a0impair brain function.<\/li>\n<li><strong>Compensatory mechanisms<\/strong>\u00a0include increased heart rate and respiration.<\/li>\n<li><strong>Neuronal damage<\/strong>\u00a0due to lack of nutrients and oxygen.<\/li>\n<li>Can lead to\u00a0<strong>seizures<\/strong>,\u00a0<strong>loss of consciousness<\/strong>, and\u00a0<strong>death<\/strong>\u00a0if not treated promptly.<\/li>\n<\/ul>\n<h1><strong>Diagnosis<\/strong><\/h1>\n<ul>\n<li>Blood glucose\u00a0<strong>&gt;600 mg\/dL<\/strong>.<\/li>\n<li>Signs of\u00a0<strong>severe dehydration<\/strong>.<\/li>\n<li><strong>Elevated hematocrit<\/strong>\u00a0(more concentrated blood).<\/li>\n<li><strong>Electrolyte imbalance<\/strong>.<\/li>\n<li>Blood pH typically\u00a0<strong>normal or slightly acidic<\/strong>\u00a0(no ketoacidosis).<\/li>\n<li>Urinalysis:\n<ul>\n<li><strong>Glucosuria<\/strong>\u00a0(glucose in urine).<\/li>\n<li>Usually\u00a0<strong>no ketones<\/strong>\u00a0(hence non-ketotic).<\/li>\n<li>Polyuria initially followed by oliguria.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h1><strong>Treatment<\/strong><\/h1>\n<ul>\n<li><strong>IV fluids<\/strong>\u00a0to correct dehydration.<\/li>\n<li>Electrolyte replacement (potassium, sodium).<\/li>\n<li><strong>Insulin therapy<\/strong>\u00a0to reduce blood glucose.<\/li>\n<li>Address\u00a0<strong>underlying stressors<\/strong>\u00a0(infection, stroke, etc.).<\/li>\n<\/ul>\n<h2><strong>Summary<\/strong><\/h2>\n<ul>\n<li>HHNK is a\u00a0<strong>life-threatening complication<\/strong>\u00a0mainly affecting\u00a0<strong>elderly<\/strong>\u00a0with\u00a0<strong>Type 2 diabetes<\/strong>.<\/li>\n<li>Characterized by\u00a0<strong>severe hyperglycemia<\/strong>\u00a0and\u00a0<strong>dehydration<\/strong>\u00a0without ketoacidosis.<\/li>\n<li><strong>Rapid treatment<\/strong>\u00a0with fluids, electrolytes, and insulin is essential to prevent\u00a0<strong>coma<\/strong>\u00a0and\u00a0<strong>death<\/strong>.<\/li>\n<\/ul>\n","protected":false},"author":1370,"menu_order":21,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":["zoe-soon"],"pb_section_license":"cc-by-nc-sa"},"chapter-type":[],"contributor":[60],"license":[57],"class_list":["post-5131","chapter","type-chapter","status-web-only","hentry","contributor-zoe-soon","license-cc-by-nc-sa"],"part":63,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5131","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/users\/1370"}],"version-history":[{"count":3,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5131\/revisions"}],"predecessor-version":[{"id":5260,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5131\/revisions\/5260"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/parts\/63"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/5131\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/media?parent=5131"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapter-type?post=5131"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/contributor?post=5131"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/license?post=5131"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}