Hyperosmolar Hyperglycemic nonketotic

syndrome (HHNS)
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is a potentially
deadly condition that can develop as a result of infection or illness in
people with uncontrolled type 2 diabetes or when diabetes medications
aren't taken as directed. Some also refer to this as a "diabetic coma."
Signs and Symptoms
• Blood glucose levels over 600 milligrams per deciliter (mg/dl)
• Frequent urination
• Extreme thirst
• Dry mouth
• Confusion or sleepiness
• Skin that is warm and dry without sweating
• Fever (usually over 101 F)
• Weakness or paralysis on one side of the body
• Loss of vision
• Hallucinations
Diagnosis
• HHNS is diagnosed based on symptoms and by measuring blood glucose
levels, which can be performed with a finger stick.

• A blood glucose level of 600 mg/dL and low ketone levels are the main factors
for diagnosis of HHNS.

• Serum osmolality, a test that measures the body's water/electrolyte balance,

also is used to diagnose HHNS. Serum osmolality specifically measures the
chemicals dissolved in the liquid part of blood (serum), such as sodium,
chloride, bicarbonate, proteins, and glucose. The test is done by taking a
sample of blood from a vein.
Diagnostic Test
• several lab tests, including blood and urine tests to measure your
blood sugar level
• kidney function and to detect infection
• Electrocardiogram if the patient is having heart problems
INTERVENTIONS

• Treatment is similar to that for DKA.

• Restore circulating blood volume and
protect against cerebral, coronary, or
renal hypoperfusion.
• Treat dehydration with rapid IV infusions
of 0.9% or 0.45% normal saline (NS) as
prescribed; dextrose is added to IV fluids
(D5NS, or 5% dextrose in 0.45% saline)
when the blood glucose level reaches 250
to 300 mg/dL.
• Treat hyperglycemia with regular insulin
administered intravenously as prescribed.
• Correct electrolyte imbalances (potassium
level may be elevated as a result of
dehydration and acidosis).
• Monitor potassium level closely because
when the client receives treatment for the
dehydration and acidosis, the serum
potassium level will decrease and
potassium replacement may be required.
• Treatment includes fluid replacement, correction of
electrolyte imbalances, and insulin administration.
• Fluid replacement in the older client must be done very
carefully secondary to potential for heart failure.
• Insulin plays a less critical role in the treatment of HHNS
than it does for the treatment of DKA because ketosis and
acidosis do not occur; rehydration alone may decrease
glucose levels.
Nursing Diagnosis
• Risk For Fluid Volume Deficit
• Risk For Infection
• Deficient Knowledge
• Imbalanced Nutrition: Less Than Body Requirements
Medical Management
• Fluids given through a vein (intravenously) to treat dehydration
• Insulin given through a vein (intravenously) to lower your blood sugar
levels
• Potassium and sometimes sodium phosphate replacement given
through a vein (intravenously) to help your cells function correctly
• Treatment typically involves starting intravenous (IV) fluids (saline solution
delivered through a needle into a vein) to rehydrate the body quickly. It also may
require IV insulin to bring down blood sugar levels.

• Potassium and sometimes sodium phosphate replenishment may also be required

to support cell function.2

• If you are hospitalized due to HHNS, you may be kept overnight for observation.
The main goal of treatment of this condition is to identify the underlying factors,
whether that's an infection, a certain medication, or poor blood sugar management.

• It is imperative that a person experiencing HHNS receive urgent professional

medical care, as complications may include seizures, coma, swelling of the brain,
or even death if left untreated