nonketotic hyperosmolar 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）』「2013/09/19 03:06:46」(JST)

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Hyperosmolar hyperglycemic state
Classification and external resources
ICD-9	250.2
DiseasesDB	29213
eMedicine	emerg/264
MeSH	D006944

Hyperosmolar hyperglycemic state (HHS) is a complication of diabetes mellitus (predominantly type 2) in which high blood sugars cause severe dehydration, increases in osmolarity (relative concentration of solute) and a high risk of complications, coma and death. It is diagnosed with blood tests. It is related to diabetic ketoacidosis (DKA), another complication of diabetes more often (but not exclusively) encountered in people with type 1 diabetes; they are differentiated with measurement of ketone bodies, organic molecules that are the underlying driver for DKA but are usually not detectable in HHS.

The treatment of HHS consists of correction of the dehydration with intravenous fluids, reduction of the blood sugar levels with insulin, and management of any underlying conditions that might have precipitated the illness, such as an acute infection.

Older names for HHS are hyperosmolar non-ketotic coma (HONK), nonketotic hyperosmolar coma, hyperosmolar hyperglycemic nonketotic syndrome (favoured by the American Diabetes Association).)

Signs and symptoms

The increasing hemoconcentration and volume depletion may result in:

• Altered mental status
• Neurologic signs including focal signs such as sensory or motor impairments or focal seizures or motor abnormalities, including flaccidity, depressed reflexes, tremors or fasciculations.
• Hyperviscosity and increased risk of thrombosis
• Ultimately, if untreated, will lead to death
• Increase thirst (polydipsia)

Diagnosis

The major differential diagnosis is diabetic ketoacidosis (DKA). In contrast to DKA, serum glucose levels in HHS are extremely high, usually greater than 40-50 mmol/L, but an anion-gap metabolic acidosis is absent or mild. Altered mental status is also more common in HHS than DKA. Although traditionally DKA has been associated with Type I Diabetes, whereas HHS has been associated with Type II, HHS can be seen in patients of both types.

Cranial imaging is not used for diagnosis of this condition. However, if MRI were performed, it may show cortical restricted diffusion with unusual characteristics of reversible T2 hypointensity in the subcortical white matter.

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 hormone-sensitive lipase (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

• Too much of a good thing: Part 2: Management of hyperosmolar hyperglycemic syndrome.

• Blouin D.SourceDepartment of Emergency Medicine, Queen's University, Kingston, Ontario.
• Canadian family physician Médecin de famille canadien.Can Fam Physician.2012 Oct;58(10):1099-100.
• PMID 23064920

• Management of diabetes and pancreatic cancer.

• Flaherty AM.SourceJohn Theurer Cancer Center, Hackensack University Medical Center, New Jersey, USA. aflaherty@HackensackUMC.org
• Oncology nursing forum.Oncol Nurs Forum.2012 Sep;39(5):440-3. doi: 10.1188/12.ONF.440-443.
• PMID 22940508

Japanese Journal

• Short-Term Case Fatality Rate and Associated Factors among Inpatients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State: A Hospital-Based Analysis over a 15-Year Period

• Chen Hua-Fen,Wang Chih-Yuan,Lee Hsin-Yu,See Ting-Ting,Chen Mei-Hsiu,Jiang Ju-Ying,Lee Ming-Tsang,Li Chung-Yi
• Internal Medicine 49(8), 729-737, 2010
• … Background and Purpose Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are usually life threatening, but the recent trend of 28-day case-fatality and associated risk factors including Charlson index have not been known. …
• NAID 130000251858

• 糖尿病性昏睡を併発した高齢者熱傷の1剖検例

• 野元 清子,佐々木 健司,森岡 康祐,副島 一孝,野崎 幹弘
• 熱傷 32(2), 73-80, 2006-06-15
• NAID 10018819744

Related Links

• Hyperosmolar hyperglycemic state - Wikipedia, the free encyclopedia

Hyperosmolar hyperglycemic state (HHS) is a complication of diabetes mellitus ( predominantly type 2) in which high blood ... Older names for HHS are hyperosmolar non-ketotic coma (HONK), nonketotic hyperosmolar coma, hyperosmolar ...

• Diabetic Coma (Hyperglycemic Hyperosmolar Nonketonic Syndrome)

16 May 2012 ... Diabetic coma -- also known as hyperglycemic hyperosmolar nonketotic syndrome -- is a serious complication that can happen to a person with diabetes who is ill or whose body is stressed. It occurs more in people with type 2 ...

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」
関連記事	「hyperosmolar」「hyperosmolar coma」

「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

「hyperosmolar」

　　[★]

• adj.

• 高浸透圧性の、高浸透圧の

関

hyperosmolality、hyperosmolarity、hyperosmosis、hyperosmotic、hypertonic、hypertonicity

「hyperosmolar coma」

　　[★]

• 高浸透圧性非ケトン性昏睡