[13] Hyperosmolar Non-Ketotic Coma

Question 1

Describe the typical patient with hyperosmolar non-ketotic coma

Answer 1

Usually T2DM, often new presentation

Usually older

Question 2

How long is the symptom history in hyperosmolar non-ketotic coma?

Answer 2

Usually long, e.g. a week

Question 3

What metabolic derangement is seen in hyperosmolar non-ketotic coma?

Answer 3

Marked dehydration
Glucose >35mM
Osmolality >340mOsmol/kg

Question 4

Is there acidosis in hyperosmolar non-ketotic coma?

Answer 4

No, as there is no ketogenesis

Question 5

What complications might arise from hyperosmolar non-ketotic coma?

Answer 5

Occlusive events are common, e.g. DVT, stroke

Question 6

How are occlusive events prevented in hyperosmolar non-ketotic coma?

Answer 6

Give LMWH

Question 7

How is hyperosmolar non-ketotic coma managed?

Answer 7

Rehydration

Look for precipitant

Question 8

How should a patient with hyperosmolar non-ketotic coma be rehydrated?

Answer 8

0.9% normal saline over 48 hours, may need about 9L

Question 9

How long should you wait before starting insulin in hyperosmolar non-ketotic coma?

Answer 9

1 hour

Question 10

Why should you wait an hour before starting insulin in hyperosmolar non-ketotic coma?

Answer 10

It may not be needed

Question 11

How much insulin should you start on in hyperosmolar non-ketotic coma?

Answer 11

Low, e.g. 1-3units per hour

Question 12

Why should you start insulin low in a hyperosmolar non-ketotic coma?

Answer 12

To avoid rapid changes in osmolality

Question 13

What might precipitate hyperosmolar non-ketotic coma?

Answer 13

MI
Infection
Bowel infarct