HYPERGLYCEMIC HYPEROSMOLAR

SYNDROME

Sidarti Soehita SFHS

Dept.of Clinical Pathology
Airlangga University Medical Faculty
 DEFINITION
HYPEROSMOLAR NONKETOTIC COMA (HONK)

Severe hyperglycemia(>600 mg/dL or >34

mmol/L)
Hyperosmolarity(>320 mOsm/L)
Dehydration in the absence of significant
ketoacidosis(the presence of ketonuria or
mild ketonemia and arterial pH<7.3 or
serum bicarbonate<15 mEq/L do not
preclude the diagnosis)
 PATHOGENESIS

Blood glucose exceeds the renal threshod

for glucoseosmotic diuresisglucosuria
and urinary loss of water,Na,K,Mg,Ca,P.
dehydration/hyperosmolality  hypovole-
miashockcoma/renal failure
 PRECIPITATING FACTORS

ACUTE ILLNESS
Infections(pneumonia,UTI,sepsis)
Myocardial infarction
CVA
GI(gastroenteritis,pancreatitis)
renal failure
burns
endocrine(hypercortisol/thyrotoxicosis)
surgery
 PRECIPITATING FACTORS

DRUGS
thiazide/furosemide
glucocorticoids
β-adrenergic blockers
cyclosporine
cimetidine
nalidixic acid
OTHER STRESSES
 LABORATORY VALUES

Plasma glucose >600 mg/dL

WBC increased
MCV artificially elevated
LFT abnormal
Potassium initially may be high, may fall
dramatically with insulin and fluid
replacement
Osmolarity >320 mOsm/L
 LABORATORY VALUES

Leucocyturia
Cholesterol/Triglyceride ↑
Blood gas analysis (pH,bicarbonate,pO2,
pCO2)
Blood/urine culture
Coagulation studies (DIC?)
Renal Function Tests abnormal