What is Hyperglycemic Hyperosmolar Nonketotic Syndrome?
It’s a severe complication of type II diabetes mellitus in which there is a high level of hyperglycemia (high blood sugar) for an extended period of time without the presence of ketones. It is also known as hyperosmolar glycemic state.
It mostly affects
- older patients
- those who don’t manage type II diabetes properly.
- those experiencing stress, trauma, or infection.
- Medical conditions like strokes or heart attacks
- Taking medications that affect the action of insulin
- Renal failure
- Heart failure
People who have this condition tend to have a blood sugar level of 600 mg/dL (33.3 mmol/L). If you can recall, the normal rate of blood sugar for a person is 60–110 mg/dL (3.3-5.6 mmol/L). It is an emergency condition that needs to be treated urgently; if not, it could be fatal.
This condition occurs when extreme hyperglycemia occurs for an extended period of time. In order for the body to attain hemostasis, the kidneys work to excrete excess glucose, which results in the expulsion of water. But if fluid loss is not replaced and carbohydrate food is not consumed, hyperglycemia occurs ten times more than the normal rate.
The loss of water causes the blood to be thicker than normal, resulting in hyperosmolarity. It’s a condition where the blood has a high level of glucose and sodium and draws water out of organs, including the brain.
No acidosis is present due to a small amount of insulin that acts on a few glucose molecules.
So, what are the signs and symptoms to look out for in a patient with this disease condition?
Clinical Manifestations
- Hypotension
- High blood glucose level
- Tachycardia (heart rate >100 bpm)
- Dry mucous membranes
- Poor skin turgor
- Seizures
- Loss of consciousness
- Frequent urination
- Mental changes like confusion, altered consciousness
- Dry mouth
- Polydipsia (extreme thirst)
Treatment
Fluid Replacement
Due to the kidney excreting the excess glucose and water, the individual needs to take sufficient fluid to regain hemostasis. Based on the patient’s serum level, 0.9% or 0.45% normal saline will be given to replace fluid loss.
When the blood glucose level has decreased to 250 to 330 mg/dL (13.8 to 16.6 mmol/L), dextrose water can be administered.
Correction of Electrolyte Imbalance
Potassium will be given to replenish minerals in the body. Potassium is not stored in the body and must be ingested every day. It helps to maintain normal levels of fluid inside the cells of the body.
Possible Insulin Administration
IV insulin is given to treat hyperglycemia and also if the serum potassium level is 3.3 mEq/L.
Because of fluid replacement and the correction of electrolyte imbalance, you’ll need to monitor and observe older patients with severe cases as
- Heart failure
- Renal failure
- Fluid overload
- Cardiac dysrhythmia
Sources
Hyperosmolar Hyperglycemic State (HHS) – Endocrine and Metabolic Disorders – MSD Manual Professional Edition
Hyperosmolar Hyperglycemic State (HHS): Treatment
Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2020). Lewis’s medical-surgical nursing: Assessment and management of clinical problems (11th ed.). Elsevier.
Saunders, N. K. (2023). Saunders NCLEX-RN Comprehensive Review (7th ed.). Elsevier.
