Hyperosmolar Syndrome

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Hyperosmolar Syndrome

Diabetes Type 2
Short-Term Complications
Hyperosmolar Syndrome
Hyperosmolar Syndrome
Hyperosmolar syndrome, a dangerous form of dehydration, is caused by untreated high blood-sugar levels.
InteliHealth Medical Content

Reviewed by the Faculty of Harvard Medical School

Hyperosmolar Syndrome
Hyperosmolar syndrome is a condition that causes severe, life-threatening loss of body fluids (dehydration). It occurs as a result of untreated very high blood sugar levels. It is seen almost exclusively in people with type 2 diabetes.
Doctors have many names for this condition. It is also known as hyperosmolar hyperglycemic nonketotic syndrome (HHNS), hyperosmolar hyperglycemic state (HHS) or hyperosmolar coma.
In order to understand this illness, it helps to know how a kidney works. As blood passes through your kidneys, the kidneys normally return most of the fluid and sodium to your bloodstream. All of the glucose also goes back into the blood. Only waste products and a small amount of fluid and salt are discarded. They leave the kidneys as urine.
When blood sugar is very high, some sugar and more water and salt also go into the urine. You urinate frequently, even while you are becoming dehydrated. Usually, you can't drink enough fluids to keep up with the water loss.
As water passes out of the body, the blood gets more concentrated. This makes blood sugar levels go up further. Hyperosmolarity is the term for blood that contains too much glucose, sodium and other dissolved substances. This condition is dangerous.
Brain cells can't function normally when the blood is too concentrated. This condition can cause a coma. First, though, you may feel confused or drowsy. The symptoms usually get worse until you get treatment.
Blood glucose levels often reach 1,000 milligrams per deciliter (mg/dl) or higher. Hyperosmolar syndrome can occur in people who do not yet know they have diabetes. It also can happen in diabetics who neglect their care. Or it can be triggered by an illness or a medicine (such as prednisone) that worsens diabetes control.
Hyperosmolar syndrome is not common in type 1 diabetics. That's because they can develop another dangerous illness. This condition is diabetic ketoacidosis. It creates symptoms at somewhat lower blood sugar levels than those in hyperosmolar syndrome. Usually a type 1 diabetic with a sugar level that is on the rise feels sick enough from ketoacidosis that he or she will see a doctor before the sugar is high enough to cause hyperosmolar syndrome.
Ketoacidosis is not very common in type 2 diabetics. Hyperosmolar syndrome occurs in people who have type 2 diabetes, when the sugar level gets extremely high.
Symptoms of hyperosmolar syndrome may include:
  • Weakness
  • Increased thirst
  • Increased urination
  • Nausea
  • Fatigue
  • Mental confusion
  • Convulsions
  • (In extreme cases) coma
Symptoms may develop gradually over days or weeks. They may not seem serious at first. Nevertheless, seek medical care right away if you notice these symptoms. Hyperosmolar coma is a life-threatening condition.
Hyperosmolar syndrome is diagnosed when blood glucose is very high (usually above 600 mg/dl) and certain substances are very concentrated in the blood. Besides glucose, these include sodium and blood urea nitrogen, or BUN.
Increases in blood sugar can develop slowly over days or weeks. Once fluid loss speeds up, changes in the blood can get worse rapidly.
You can prevent hyperosmolar syndrome by keeping track of your blood sugar (especially when you're sick) and taking your diabetes medicines. It can help to drink more water when the sugar is high. However, this is not a substitute for medicine.
A hyperosmolar condition is a medical emergency. Two emergency treatments are needed:
  • Fluids in a vein to correct the dehydration
  • Insulin to reduce blood sugar
A person with hyperosmolar symptoms usually needs to be put in a hospital.
Treatment must be aggressive. Once the correct treatment begins, the condition can turn around quickly.
Improvement usually occurs within hours. Timely treatment can prevent permanent damage. But hyperosmolar syndrome can cause death, even with the correct treatment.
Hyperosmolar syndrome is a high risk illness in part because of who develops it. It's seen mainly in older people with cardiovascular disease. They have little reserve to recover from a severe illness.
Some people don't seek treatment fast enough. Almost half of those who go into a coma with this disease die from it.


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Last updated October 01, 2014

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