Hyperosmolar Syndrome

Hyperosmolar syndrome: an introduction

Hyperosmolar syndrome, including hyperosmolar nonketotic coma, is a potentially dangerous short-term complication of diabetes that mostly affects elderly patients with either type 1 or type 2 diabetes. It occurs when a person with diabetes develops blood sugar that is extremely high. Unlike ketoacidosis, there little or no production of ketones occurs with hyperosmolar syndrome. The term hyperosmolar refers to increased levels of sugar and salts in the blood.1

Hyperosmolar syndrome is one of the most serious short-term complication of diabetes. It occurs less often than ketoacidosis, but is associated with a greater chance of death. Therefore, hyperosmolar syndrome must be taken seriously and considered a medical emergency when it occurs.1

What is the cause of hyperosmolar syndrome?

Hyperosmolar syndrome occurs when a person with diabetes develops blood sugar that is extremely high. The term “hyperosmolar” refers to increased levels of sugar and salts in the blood. Hyperosmolar syndrome can result in hyperosmolar nonketotic coma, which can be life-threatening and usually occurs in older adults with type 2 diabetes, who stop taking diabetes medications as directed, develop an infection or other illness, become dehydrated, or take other medication that affect blood sugar levels. The term nonketotic means that ketones, which are characteristic of ketoacidosis, are not present in the blood with hyperosmolar syndrome.2

Who is at risk for hyperosmolar syndrome?

In contrast with ketoacidosis, which is most common in people with type 1 diabetes, hyperosmolar syndrome, though rare, is more frequently associated with type 2 diabetes. It typically occurs in a person with diabetes who is not taking insulin as directed (in some cases, a person’s insulin pump may not be working properly), someone who is taking certain medications or illegal drugs that affect how the body uses carbohydrates, a person who is fasting or who is consuming large amounts of alcohol, and someone who becomes dehydrated. A person with diabetes who has a major health problem, such as a heart attack, kidney disease, or an infection, is also at risk for hyperosmolar syndrome. Eating disorders, fear of gaining weight, or efforts to prevent hypoglycemia, as well as psychological problems, particularly in younger patients who are rebelling against authority may contribute to risk of hyperosmolar syndrome.2,3

Causes of hyperosmolar syndrome

Major illness
  • Body unable to use glucose, burns fat instead causing a build-up of ketones in blood
Untreated diabetes
  • Certain major illnesses (eg, heart attack, kidney disease, pancreatitis, stroke, infections)
Medications or illict drugs
  • Certain medications (eg, glucocorticoids, high-dose thiazide diuretics) or illegal drugs (cocaine) may interfere with carbohydrate metabolism
Insulin not taken as directed
  • Certain medications (eg, glucocorticoids, high-dose thiazide diuretics) or illegal drugs (cocaine) may interfere with carbohydrate metabolism
Fasting or alcohol abuse
  • CBoth fasting and consumption of large amounts of alcohol may affect blood glucose levels

What are the symptoms of hyperosmolar syndrome?

The initial symptoms of hyperosmolar syndrome include2:

If unaddressed (if the symptoms above persist for a few days), hyperosmolar syndrome may result in loss of consciousness and coma.2

How is hyperosmolar syndrome detected?

There are several tests that are done to tell whether you have hyperosmolar syndrome. These include serum glucose, serum electrolytes, serum creatinine, and plasma osmolality.2,3

How is hyperosmolar syndrome treated?

If you have hyperosmolar syndrome, your body has lost fluids and important chemicals that your body requires to function normally. Treatment for hyperosmolar syndrome requires replacing lost fluids and electrolytes (chemicals including potassium and sodium) and re-establishing the normal healthy balance of these components in your blood. This is done with an intravenous infusion of fluids and electrolytes. Treatment for hyperosmolar syndrome also requires making sure that your body has the insulin it needs to use glucose for energy.2

How can I prevent hyperosmolar syndrome?
As with many complications of diabetes, hyperosmolar syndrome can be prevented by closely monitoring your blood sugar and maintaining it at the right level and taking your diabetes medication as directed and learning how to adjust your medication if you develop symptoms of hyperosmolar syndrome.2

Written by: Jonathan Simmons | Last reviewed: May 2014.
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