Diabetic Hyperosmolar Syndrome

Diabetic Hyperosmolar Syndrome

Diabetic hyperosmolar syndrome is a metabolic derangement that occurs in patients with diabetes mellitus especially type 2 diabetes. It is characterized by hyperglycaemia, hyperosmolarity, and dehydration without significant ketoacidosis. Hence it is called hyperglycaemic, hyperosmolar, non ketotic coma [HHNKC]

Causes and risk factors

HHKNC is characterised by severe hyperglycaemia, increase in serum osmolality without accumulation of ketone bodies. Hyperglycaemia is caused due to either deficiency of insulin or resistance to insulin from tissue cells. This results in increased gluconeogenesis and glycogenolysis. Reduced uptake of glucose by peripheral tissues causes increase of glucose levels in blood leading to Hyperglycaemia. Increased osmolality in extracellular fluid results in shift of water from intracellular to extracellular space leading to intracellular dehydration. Initially hyperglycaemia is controlled by excretion of glucose through urine [glycosuria.]but at disease progresses stress on the kidneys increase causing profound hyperglycaemia  and dehydration leading to increased production of counter regulatory hormones like cortisol. Underlying infection such as pneumonia, dental or a urinary tract infection, trauma, burns, other illness such as infarction or stroke, alcohol excess, excessive consumption of beverages, medications that lower glucose tolerance or increase fluid loss , parentral diuretics are  responsible for developing HHKNC. Sometimes undiagnosed diabetes results in diabetic hyperosmolar syndrome. Impaired thirst, limited access to water, older age, poor kidney function, poor management of diabetes, stopping insulin or other medications that lower glucose levels are some of the precipitating factors.

Clinical presentation

Polydipsia [excessive thirst], polyuria [high urine output], dryness of mouth are the prominent features. As disease progresses, symptoms like fatigue, drowsiness, fever, warmth of skin without perspiration, nausea and vomiting, cramps in leg, disturbed vision, nystagmus, speech impairment, muscular dysfunction, confusion, hallucinations, altered level of consciousness, depressed sensorium are observed in case of HHKNC. In severe cases patient may land into coma.


Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Complete blood count, Blood glucose levels, serum electrolyte levels, urinary ketone levels, arterial blood gases, renal function tests are the necessary investigations for HHKNC.


Treatment involves administration of intravenous fluids, insulin to lower blood sugar levels, necessary electrolytes to correct fluid-electrolyte imbalance. Treating the precipitating causes will contribute further to the treatment. It is kind of medical emergency. Patient is hospitalised and monitored for all parameters.

Other Modes of treatment

The other modes of treatment can also be effective in treating HHKNC. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating HHKNC.

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