eMedicine Specialties > Endocrinology > Diabetes Mellitus

Hyperosmolar Coma: Follow-up

Author: J Michael Gonzalez-Campoy, MD, PhD, FACE, Medical Director and CEO, MN Center for Obesity, Metabolism, and Endocrinology
Contributor Information and Disclosures

Updated: Jun 1, 2009

Follow-up

Further Outpatient Care

  • Following an episode of HNS, enroll all patients in a program of routine diabetes care.
  • Adhere to American Diabetes Association guidelines for care of people with diabetes.
  • For patients with unknown diabetes prior to HNS, perform a dilated eye examination.
  • Advise patients treated with insulin to wear a bracelet or chain identifying them as having diabetes.

Deterrence/Prevention

Having had HNS places patients at risk for further episodes. Patient education is important in preventing a recurrence of HNS. Warn patients to avoid poor glycemic control and dehydration.

Complications

See Mortality/Morbidity.

Patient Education

A certified diabetes educator should instruct all patients on management of sick days and a thorough review of self-care.

 


More on Hyperosmolar Coma

Overview: Hyperosmolar Coma
Differential Diagnoses & Workup: Hyperosmolar Coma
Treatment & Medication: Hyperosmolar Coma
Follow-up: Hyperosmolar Coma
References
Further Reading
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References

  1. Campanella LM, Lartey R, Shih R. Severe hyperglycemic hyperosmolar nonketotic coma in a nondiabetic patient receiving aripiprazole. Ann Emerg Med. Feb 2009;53(2):264-6. [Medline].

  2. Ahuja N, Palanichamy N, Mackin P, et al. Olanzapine-induced hyperglycaemic coma and neuroleptic malignant syndrome: case report and review of literature. J Psychopharmacol. Nov 21 2008;[Medline].

  3. Bartoli E, Sainaghi PP, Bergamasco L, et al. Hyperosmolar coma due to exclusive glucose accumulation: recognition and computations. Nephrology (Carlton). Apr 2009;14(3):338-44. [Medline].

  4. Bartoli E, Bergamasco L, Castello L, et al. Methods for the quantitative assessment of electrolyte disturbances in hyperglycaemia. Nutr Metab Cardiovasc Dis. Jan 2009;19(1):67-74. [Medline].

  5. American Diabetes Association. Hospital admission guidelines for diabetes. Diabetes Care. Jan 2004;27 Suppl 1:S103. [Medline]. [Full Text].

  6. Kitabchi AE, Umpierrez GE, Murphy MB, et al. Hyperglycemic crises in diabetes. Diabetes Care. Jan 2004;27 Suppl 1:S94-102. [Medline]. [Full Text].

  7. Fishbein H, Palumbo PJ. Acute Metabolic Complications in Diabetes. In: National Diabetes Data Group. Diabetes in America. 2nd ed. Bethesda, Md: National Institute of Diabetes and Digestive and Kidney Disease; 1995:283-91.

  8. Gonzalez-Campoy JM, Robertson RP. Diabetic ketoacidosis and hyperosmolar nonketotic state: gaining control over extreme hyperglycemic complications. Postgrad Med. Jun 1996;99(6):143-52. [Medline].

  9. Stoner GD. Hyperosmolar hyperglycemic state. Am Fam Physician. May 1 2005;71(9):1723-30. [Medline]. [Full Text].

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Keywords

hyperosmolar coma, diabetic coma, hyperosmolar nonketotic, hyperosmolar nonketotic coma, diabetes, diabetes mellitus, diabetes type 1, diabetes type 2, type 2 diabetes, type 1 diabetes, diabetes 2, diabetes 1, diabetic, insulin, insulin resistance, glucose, blood sugar, hyperglycemia, hyperosmolar nonketotic state

hyperglycemic hyperosmolar nonketotic syndrome, hyperosmolar hyperglycemic syndrome, diabetic hyperosmolar state, hyperosmolar hyperglycemic nonketotic coma, nonketotic hypertonicity, diabetes mellitus type2, diabetes mellitus type 1, type 2 diabetes mellitus, type 1 diabetes mellitus

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Contributor Information and Disclosures

Author

J Michael Gonzalez-Campoy, MD, PhD, FACE, Medical Director and CEO, MN Center for Obesity, Metabolism, and Endocrinology
J Michael Gonzalez-Campoy, MD, PhD, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, American Medical Association, and Minnesota Medical Association
Disclosure: Nothing to disclose.

Medical Editor

David S Schade, MD, Chief, Division of Endocrinology and Metabolism, Department of Internal Medicine, Professor, University of New Mexico School of Medicine and Health Sciences Center
David S Schade, MD is a member of the following medical societies: American College of Physicians, American Diabetes Association, American Federation for Medical Research, Endocrine Society, New Mexico Medical Society, New York Academy of Sciences, and Society for Experimental Biology and Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Don S Schalch, MD, Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics
Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical Research, and Endocrine Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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