hyperosmolar nonketotic coma

高浸透圧性非ケトン性昏睡

WordNet

1. (botany) a usually terminal tuft of bracts (as in the pineapple) or tuft of hairs (especially on certain seeds)
2. a state of deep and often prolonged unconsciousness; usually the result of disease or injury (同)comatoseness
3. (astronomy) the luminous cloud of particles surrounding the frozen nucleus of a comet; forms as the comet approaches the sun and is warmed

PrepTutorEJDIC

1. こん睡状態
2. コマ(彗星(すいせい)の核の周囲の星雲状物質) / (レンズの)非対称収差 / (種子の)種綿(たねわた)
3. 『来たるべき』,『次の』 / 《話》前途有望な,今売り出し中の;新進の / (…の)『到来』,接近,致着(arrival)《+『of』+『名』》

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/07/02 17:39:03」(JST)

wiki en

[Wiki en表示]

Nonketotic hyperosmolar coma
Classification and external resources
ICD-9	250.2
DiseasesDB	29213
eMedicine	emerg/264
MeSH	D006944

Nonketotic hyperosmolar coma (nonketotic hyperglycaemia) is a type of diabetic coma associated with a high mortality seen in diabetes mellitus type 2. The preferred term used by the American Diabetes Association is Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS). Other commonly used names are hyperosmolar hyperglycemic nonketotic coma (HHNKC) or hyperosmotic non-ketotic coma (HONKC). It is also called hyperosmolar hyperglycemic state (HHS), as some patients may have some ketonuria and it does not necessarily cause coma.

Signs and symptoms

The increasing hemoconcentration and volume depletion may result in:

• Hyperviscosity and increased risk of thrombosis.
• Disordered mental functioning.
• Neurologic signs including focal signs such as sensory or motor impairments or focal seizures or motor abnormalities, including flaccidity, depressed reflexes, tremors or fasciculations.
• Ultimately, if untreated, will lead to death.

Pathophysiology

Nonketotic coma is usually precipitated by an infection, myocardial infarction, stroke or another acute illness. A relative insulin deficiency leads to a serum glucose that is usually higher than 33 mmol/l (600 mg/dl), and a resulting serum osmolarity that is greater than 320 mOsm. This leads to polyuria (excessive urination, an osmotic diuresis), which, in turn, leads to volume depletion and hemoconcentration that causes a further increase in blood glucose level. Ketosis is absent because the presence of some insulin inhibits lipolysis.

Management

Intravenous fluids

Treatment of HHS begins with reestablishing tissue perfusion using intravenous fluids. People with HHS can be dehydrated by 8 to 12 L. Attempts to correct this usually take place over 24 hrs with initial rates of normal saline often in the range of 1 L/hr for the first few hours.

Electrolyte replacement

Severe potassium deficits often occur in HHS. They usually range around 350 mEq in a 70 kg person. This is generally replaced at a rate 10 mEq per hour as long as there is urinary output.

Insulin

Insulin is given to reduce blood glucose concentration; however, as it also causes the movement of potassium into cells, serum potassium levels must be sufficiently high or dangerous hypokalemia may result. Once potassium levels have been verified to be greater than 3.3 mEq/l, then an insulin infusion of 0.1 units/kg is begun.

References

UpToDate Contents

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• 1. 成人における糖尿病性ケトアシドーシスおよび高浸透圧性高血糖状態：治療 diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults treatment
• 2. 成人における糖尿病性ケトアシドーシスおよび高浸透圧性高血糖状態：臨床的特徴、評価、および診断 diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults clinical features evaluation and diagnosis
• 3. 成人における糖尿病性ケトアシドーシスおよび高浸透圧性高血糖状態：疫学および病因 diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults epidemiology and pathogenesis
• 4. 小児および思春期における2型糖尿病の疫学、症状、および診断 epidemiology presentation and diagnosis of type 2 diabetes mellitus in children and adolescents
• 5. 小児および思春期における2型糖尿病の併存疾患および合併症 comorbidities and complications of type 2 diabetes mellitus in children and adolescents

English Journal

• Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.

• Fayfman M1, Pasquel FJ1, Umpierrez GE2.
• The Medical clinics of North America.Med Clin North Am.2017 May;101(3):587-606. doi: 10.1016/j.mcna.2016.12.011.
• PMID 28372715

• Cerebral edema among adults with diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome: Incidence, characteristics, and outcomes.

• Siwakoti K1, Giri S1, Kadaria D1.
• Journal of diabetes.J Diabetes.2017 Feb;9(2):208-209. doi: 10.1111/1753-0407.12448. Epub 2016 Aug 31.
• PMID 27423142

• Hamman syndrome: pneumomediastinum combined with hyperosmolar hyperglycemic state.

• Hirayama I1, Hiruma T2, Ueda Y2, Doi K2, Nakajima S2.
• The American journal of emergency medicine.Am J Emerg Med.2016 Oct;34(10):2058.e1-2058.e2. doi: 10.1016/j.ajem.2016.03.039. Epub 2016 Mar 17.
• PMID 27055605

Related Links

• Diabetic hyperglycemic hyperosmolar syndrome ...

Symptoms may include any of the following: Coma Confusion Convulsions Dry mouth, dry tongue Fever Increased thirst Increased urination (at the beginning of the syndrome) Lethargy Nausea Weakness Weight loss

• Hyperosmolar Hyperglycemic State: Background ...

HHS was previously termed hyperosmolar hyperglycemic nonketotic coma (HHNC); however, the terminology was changed because coma is found in fewer than 20% of patients with HHS. [1] HHS most commonly occurs in : ...

Related Pictures

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★リンクテーブル★

リンク元	「高浸透圧性非ケトン性昏睡」
拡張検索	「hyperglycemic hyperosmolar nonketotic coma」
関連記事	「hyperosmolar」

「高浸透圧性非ケトン性昏睡」

　　[★]

英

nonketotic hyperosmolar coma (HIM) non-ketotic hyperosmolar coma, hyperosmolar non-ketotic coma(DMR) HONK hyperosmolar nonketotic coma

同

高血糖高浸透圧昏睡、糖尿病性高血糖性高浸透圧性昏睡 hyperglycemic hyperosmolar nonketotic coma hyperglycemic hyperosmolar non-ketotic coma(DMR) HHNC、高浸透圧性非ケトン性糖尿病昏睡 hyperosmolar non-ketotic diabetic coma hyperosmolar nonketotic diabetic coma HONK、非ケトン性高血糖性昏睡 nonketotic hyperglycemic coma、非ケトン性高浸透圧性昏睡

hyperglycemic hyperosmolar state？ HHS？ (HIM)

関

糖尿病

[show details]

高浸透圧性非ケトン性昏睡 : 約 35,000 件
非ケトン性高浸透圧性昏睡 : 約 9,010 件

概念

• 2型糖尿病が基礎にある。
• 50歳以上に好発し、インスリン非依存性糖尿病患者が腎不全や中枢神経障害、悪性腫瘍、消化器疾患、呼吸器感染などを合併するときに多くみられ、ステロイドや利尿薬の投与、輸液や高カロリー補給、人工透析などの際に医原性に起きやすい。

鑑別

• 糖尿病性ケトアシドーシス

• 呼吸(Kussmaul呼吸があるわけではない。代謝性アシドーシスの呼吸性代償が必要ないことが多い？)
• 尿中ケトン体、動脈血HCO3-

国試

• 105A021

「hyperglycemic hyperosmolar nonketotic coma」

　　[★]

糖尿病性高血糖性高浸透圧性昏睡

「hyperosmolar」

　　[★]

• adj.

• 高浸透圧性の、高浸透圧の

関

hyperosmolality、hyperosmolarity、hyperosmosis、hyperosmotic、hypertonic、hypertonicity