Diabetic Hyperglycemic Hyperosmolar syndrome, not cetósico hyperosmolar hyperglycemic coma (NKHHC), hyperosmolar coma non-ketone (Honk)

Hyperosmolar hyperglycemic diabetic (HHS) is a complication of type 2 diabetes that involves blood sugar very high (glucose) without the presence of ketones. Ketones are byproducts of fat breakdown.

Causes, incidence, and risk factors

Diabetic hyperglycemic hyperosmolar syndrome is a condition of:

  • The blood extremely high blood sugar (glucose).
  • Extreme lack of water ( dehydration ).
  • Decrease of consciousness.

The accumulation of ketones in the body (ketoacidosis) may also occur.

This condition is often seen in people with type 2 diabetes. It can occur in those who have not been diagnosed with diabetes, or in people who have not been able to control their diabetes. The condition may be caused by:

  • Infection
  • Another disease
  • Medications that lower glucose tolerance or increase fluid loss (in people who are losing or not getting enough fluid)
  • Normally, the kidneys try to compensate for the levels of glucose in the blood, allowing the extra glucose to leave the body in the urine. If you do not drink enough fluids, or you drink fluids that contain sugar, the kidneys can no longer rid itself of excess glucose. The levels of glucose in the blood can become very high for it. The blood then becomes much more concentrated than normal (hyperosmolarity).
  • Hyperosmolarity is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances that normally carry water to the bloodstream. This attracts the water from other organs of the body, including the brain. Hyperosmolarity creates a cycle of increasing blood glucose levels and dehydration.

The risk factors include:

  • A stressful event such as an infection, a heart attack , stroke, or recent surgery
  • Congestive heart failure
  • Impairment of thirst
  • Limited access to water (especially in patients with dementia or who are bedbound)
  • The elderly
  • Poor kidney function
  • Poor management of diabetes – not following the treatment plan as directed
  • Suspension of insulin or other drugs that reduce levels of glucose

The symptoms of Diabetic Hyperglycemic Hyperosmolar syndrome

  • Eat
  • Confusion
  • Seizures
  • Increased thirst
  • Increased urination (at the beginning of the syndrome)
  • Lethargy
  • Nausea
  • Weakness
  • Weight loss
  • The symptoms may get worse over a period of days or weeks.

Other symptoms that may occur with this disease:

  • Movement dysfunctional
  • Loss of feeling or function of muscles
  • Language impairment
  • Signs and tests
  • The signs may include:
  • Extreme dehydration
  • High temperature – over 38 degrees celsius (100.4 degrees Fahrenheit)
  • The increase in heart rate
  • Blood pressure low systolic

Results of the exam are:

  • High serum osmolarity (concentration)
  • Higher than normal BUN and creatinine
  • Higher than normal serum sodium
  • The accumulation of ketones in mild (ketosis)
  • Very high glucose in blood
  • Evaluation of the possible causes may be:
  • Blood cultures
  • A chest x-ray
  • Electrocardiogram (ECG)
  • A urine analysis


  • The goal of treatment is to correct dehydration. This will improve the blood pressure, the diuresis and the circulation.
  • Fluids and potassium will be given through a vein ( intravenously ). High levels of glucose ??treated with intravenous insulin.

Expectations (prognosis)

Patients who develop this syndrome are often already ill. The mortality rate with this condition is up to 40%.


  • Acute colapso circulatory (shock)
  • Formation of blood clots
  • Inflammation of the brain (cerebral edema)
  • The increase of acid levels in the blood (lactic acidosis)

Call your health care provider

This condition is a medical emergency. Go to the emergency room or call the local emergency number if you develop symptoms of diabetic hyperglycemic hyperosmolar syndrome.


The control of type 2 diabetes and recognizing the early signs of dehydration and infection can help prevent this condition.